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Journal articles on the topic 'Diagnostic Proportions'
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Dukarm, James, Zachary Draper, and Tomasz Piotrowski. "Diagnostic Simplexes for Dissolved-Gas Analysis." Energies 13, no. 23 (December 7, 2020): 6459. http://dx.doi.org/10.3390/en13236459.
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A Duval triangle is a diagram used for fault type identification in dissolved-gas analysis of oil-filled high-voltage transformers and other electrical apparatus. The proportional concentrations of three fault gases (such as methane, ethylene, and acetylene) are used as coordinates to plot a point in an equilateral triangle and identify the fault zone in which it is located. Each point in the triangle corresponds to a unique combination of gas proportions. Diagnostic pentagons published by Duval and others seek to emulate the triangles while incorporating five fault gases instead of three. Unfortunately the mapping of five gas proportions to a point inside a two-dimensional pentagon is many-to-one; consequently, dissimilar combinations of gas proportions are mapped to the same point in the pentagon, resulting in mis-diagnosis. One solution is to replace the pentagon with a four-dimensional simplex, a direct generalization of the Duval triangle. In a comparison using cases confirmed by inspection, the simplex outperformed three ratio methods, Duval triangle 1, and two pentagons.
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Berry, C. C. "A tutorial on confidence intervals for proportions in diagnostic radiology." American Journal of Roentgenology 154, no. 3 (March 1990): 477–80. http://dx.doi.org/10.2214/ajr.154.3.2106207.
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Ross, Marshall, Sasha Selby, Naveen Poonai, Helena Liu, Shabnam Minoosepehr, Graham Boag, Robin Eccles, and Graham Thompson. "The Effect of a Full Bladder on Proportions of Diagnostic Ultrasound Studies in Children with Suspected Appendicitis." CJEM 18, no. 6 (April 4, 2016): 414–19. http://dx.doi.org/10.1017/cem.2016.23.
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AbstractObjectivesWe examined the effect of a full bladder on proportions of diagnostic ultrasound (US) studies in children with suspected appendicitis. We also examined the effect of a full bladder on proportions of fully visualized ovaries on US in children with suspected appendicitis.MethodsWe conducted a retrospective health record review of children aged 2-17 years presenting to a tertiary pediatric emergency department (ED) with suspected appendicitis who had an ultrasound performed. We compared proportions of diagnostic US studies in children with full and sub-optimally filled bladders. We also compared proportions of ovarian visualization in females with full and sub-optimally filled bladders.Results678 children were included in our final analysis. The proportion of diagnostic US studies did not vary significantly between groups with a full (132/283, 47%, 95% confidence interval [CI] 38%-56%) or sub-optimally filled bladder (205/395, 52%, 95% CI 47%-57%)(p=0.17). Rates of ovarian visualization were higher in females with a full bladder (196/205, 96%, 95% CI 93%-99%) compared to those with a sub-optimally filled bladder (180/223, 81%, 95% CI 76%-86%) (p<0.01).ConclusionsAdministrators and clinical decision makers should consider removing routine bladder filling practice from current pediatric appendicitis protocols in males and in pre-pubertal females where ovarian pathology is not suspected. Selective bladder filling prior to US should be performed in females when ovarian pathology is suspected.
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Ju, X., D. N. Teusner, A. J. Spencer, and D. S. Brennan. "Longitudinal Changes in Proportions of Dental Services Provided by Australian Dentists, 1983 to 2010." JDR Clinical & Translational Research 2, no. 2 (December 7, 2016): 109–18. http://dx.doi.org/10.1177/2380084416681479.
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The objective of the study was to estimate the longitudinal change over a 26-y period in the proportion of dental services provided in 10 main service provision areas by Australian dentists. A random sample of Australian dentists was surveyed approximately every 5 y, commencing 1983 to 1984. The mean proportion of dental services provided was calculated from practitioner activity logs. Mixed effects regression models estimated the longitudinal change in the proportion of services provided, by dentists’ age and birth-year cohort. Response rates across data collection waves ranged from 67% to 76%. Between 1983 to 1984 and 2009 to 2010, the mean proportion of diagnostic, preventive, and crown/bridge services provided tended to increase, and the mean proportion of restorative, oral surgery, and prosthodontic services tended to decrease. Mean proportions of endodontic and orthodontic services fluctuated. Relative to the youngest cohort (born after 1984), across cohorts of older to younger dentists, the proportions of diagnostic and preventive services increased, and restorative and prosthodontic decreased. Older cohorts provided the lowest proportions of diagnostic and preventive services (oldest cohort born before 1918: β = −32.1 ± 4.8; cohort born 1934 to 1938: β = −11.6 ± 3.2, respectively). Older cohorts provided the highest proportions of restorative and prosthodontic services (born before 1918: β = 27.3 ± 5.6; born 1919 to 1923: β = 10.5 ± 2.4, respectively). Some service area trends varied across birth-year cohorts. Endodontic service provision was declining for younger cohorts but increasing for older cohorts. Preventive service provision was increasing for younger cohorts but declining for older cohorts. This study identified trends not evident in previous time-series analysis. First, provision of restorative and oral surgery services, as a proportion of all services provided, was declining. Second, there were competing intercohort trends. These may indicate that new norms in dental education are influencing clinical decision making and that new trends in dental service provision may emerge as older dentists retire. Knowledge Transfer Statement: This study identified several trends in dental service provision and indicated that not all trends were consistent across all birth-year cohorts. Findings inform dental health care policy and priorities for dental education. In addition, the identified trends have implications for the future composition of the oral health workforce.
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Busse, R., and C. Schwenke. "Analysis of Differences in Proportions from Clustered Data with Multiple Measurements in Diagnostic Studies." Methods of Information in Medicine 46, no. 05 (2007): 548–52. http://dx.doi.org/10.1160/me0433.
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Summary Objectives: In diagnostic studies, proportions such as sensitivities are often to be calculated and to be compared between different diagnostic procedures. As statistical unit of analysis, multiple observational units may be assessed within each patient, i.e., multiple lesions in an organ. As a requirement, these are to be assessed by multiple blinded readers. In this paper we propose a method to cover correlations between units within patients, correlations between procedures and correlations between different raters assessing each observational unit. Methods: The proposed approach is a two-step method to analyze clustered data with multiple measurements to compare diagnostic procedures in a paired modality design and the correlation between the readers in a paired reader design. The performance of the approach was compared to a generalized estimation equations model (GEEs) by power simulations. Results: Power simulations suggest, that the two-step approach is not inferior to GEEs with regard to the single readers as well as with regard to the average reader. Conclusions: An intuitive approach was developed next to established methods to analyze “paired modality, paired reader” and “unpaired modality, paired reader” studies with binary endpoints when estimating proportions and differences in proportions for clustered data with multiple measurements. This two-step approach is an alternative method to cover routine designs of diagnostic studies where the difference of proportions is to be estimated directly along with confidence intervals.
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Mandelli, Laura, Angelo Arminio, Anna-Rita Atti, and Diana De Ronchi. "Suicide attempts in eating disorder subtypes: a meta-analysis of the literature employing DSM-IV, DSM-5, or ICD-10 diagnostic criteria." Psychological Medicine 49, no. 08 (November 29, 2018): 1237–49. http://dx.doi.org/10.1017/s0033291718003549.
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AbstractBackgroundQuantification of suicidal risk in specific populations is important for the adoption of targeted prevention and harm reduction measures. Though there remains little systematic evidence, risk of suicide attempts for bulimia nervosa (BN) and binge-purging anorexia nervosa (AN-bp) appears higher than restrictive AN (AN-r); risk in binge eating disorder (BED) is still unclear. The aim of this meta-analysis was to compare proportions of suicide attempts in eating disorder (ED) subgroups.MethodsA literature search using combinations of key-words for ED and suicide attempts was performed. Studies reporting proportions of suicide attempters in at least two ED groups, diagnosed according to DSM-IV or -5 and ICD-10 diagnostic criteria were considered. ED subgroups were analyzed in pairs using a binary random effect model for proportions. Publication bias, meta-regression, and sensitivity analyses were performed.ResultsIn BN, attempted suicide was more frequent (21%) than in AN (12.5%), but the difference was statistically significant only when BN was compared with AN-r (9–10%). In BED, the proportion of suicide attempts was as high as in AN (10–12%).ConclusionsThough limited by heterogeneity across the studies in terms of methodology and aims, inability to control for relevant confounding variables, exclusion of ED not otherwise specified, this study supports suicide attempts as a major issue in EDs, especially in binge-purging subtypes, i.e. BN and AN-bp. Similar suicidal proportions were observed in AN and BED. The reasons for a greater proportion of attempted suicide in binge/purging subtypes need to be explored in future studies.
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Burke, Rachael M., Saulos Nyirenda, Hussein H. Twabi, Marriott Nliwasa, Elizabeth Joekes, Naomi Walker, Rose Nyirenda, et al. "Design and protocol for a cluster randomised trial of enhanced diagnostics for tuberculosis screening among people living with HIV in hospital in Malawi (CASTLE study)." PLOS ONE 17, no. 1 (January 10, 2022): e0261877. http://dx.doi.org/10.1371/journal.pone.0261877.
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Background People living with HIV (PLHIV) have a high risk of death if hospitalised in low-income countries. Tuberculosis has long been the leading cause of admission and death, in part due to suboptimal diagnostics. Two promising new diagnostic tools are digital chest Xray with computer-aided diagnosis (DCXR-CAD) and urine testing with Fujifilm SILVAMP LAM (FujiLAM). Neither test has been rigorously evaluated among inpatients. Test characteristics may be complementary, with FujiLAM especially sensitive for disseminated tuberculosis and DCXR-CAD especially sensitive for pulmonary tuberculosis, making combined interventions of interest. Design and methods An exploratory unblinded, single site, two-arm cluster randomised controlled trial, with day of admission as the unit of randomisation. A third, smaller, integrated cohort arm (4:4:1 random allocation) contributes to understanding case-mix, but not trial outcomes. Participants are adults living with HIV not currently on TB treatment. The intervention (DCXR-CAD plus urine FujiLAM plus usual care) is compared to usual care alone. The primary outcome is proportion of participants started on tuberculosis treatment by day 56, with secondary outcomes of mortality (time to event) measured to to 56 days from enrolment, proportions with undiagnosed tuberculosis at death or hospital discharge and comparing proportions with enrolment-day tuberculosis treatment initiation. Discussion Both DCXR-CAD and FujiLAM have potential clinical utility and may have complementary diagnostic performance. To our knowledge, this is the first randomised trial to evaluate these tests among hospitalised PLHIV.
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Hoa Tran, An, Minh Man Pham Bui, and Thuong Dieu Thi Trinh. "Survey the proportions of TCM symptoms and patterns in stable COPD patients at University Medical Center HCMC." MedPharmRes 6, no. 4 (April 20, 2022): 11–16. http://dx.doi.org/10.32895/ump.mpr.6.4.2.
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Introduction: COPD affects the quality of a patient’s life and leads to death. Identifying TCM symptoms and clinical patterns proportions in the community will make diagnosis and treatment more effective. In Vietnam, there were no epidemiological documents about COPD in TCM. Therefore, this study wished to survey stable COPD patients to find out the proportions of symptoms and patterns in TCM to create a basis for further practice. Methods: The survey was conducted as a descriptive cross-sectional study. Participants were stable COPD outpatients at the Clinic and respiratory function test of the University Medical Center HCMC from September to December 2018. According to the survey form based on the TCM diagnostic criteria, the proportions of symptoms and patterns were recorded. Results: After three months, 116 patients were recruited. The proportions of 30 TCM symptoms and signs were recorded. The proportions of patients were as follows: 80.17% met Lung qi deficiency, 76.72% for Lung-kidney qi deficiency, 53.45% for Lung-kidney qi and yin deficiency, 47.41% for Lung-spleen qi deficiency, and 2.59% for not meeting any of the diagnostic criteria. Patterns were overlapping in the same patients. Conclusions: All TCM symptoms and patterns in the diagnostic criteria appeared in COPD patients. The deficiency of the Lung and Kidney was the most common. Most patients were classified into many different patterns with multi organs damage. More multicenter studies with bigger participants numbers are suggested.
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Copeland, J. R. M., B. J. Gurland, M. E. Dewey, M. J. Kelleher, A. M. R. Smith, and I. A. Davidson. "Is There More Dementia, Depression and Neurosis in New York?" British Journal of Psychiatry 151, no. 4 (October 1987): 466–73. http://dx.doi.org/10.1192/bjp.151.4.466.
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A computerised diagnosis, AGECAT, is applied to data from random community samples of the elderly in New York and London in order to examine the prevalence of mental illness in the two cities, especially the result reported from the same study, using a different diagnostic procedure, that the proportion of dementia was higher in New York. The greater proportion of dementia in New York is confirmed for all AGECAT's levels of diagnostic confidence, for both sexes and at all half-decades over 65 years. Provided that this difference is upheld and genetic differences can be discounted, these findings would seem to support a contributory environmental cause for dementia. Proportions of depression as a whole are similar in both cities. Syndrome case and sub-case levels of neurotic disorder are generally higher in London.
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Kononov, Jake, Jim Williams, and Catherine Durso. "A Closer Look at Highway Safety Diagnostics and Crash Analysis." Transportation Research Record: Journal of the Transportation Research Board 2674, no. 5 (April 26, 2020): 1–11. http://dx.doi.org/10.1177/0361198120913298.
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Diagnostic methods in the context of the Highway Safety Manual (HSM) aim to identify abnormalities or patterns in crash occurrence which may provide an important clue to an effective remedy. These methods are used to assess the nature of the safety problem and on its basis select a countermeasure for which there is a known crash modification factor. Two approaches are presently used to perform diagnostic examinations: the test of proportions and crash type-specific safety performance functions (SPFs). The test of proportions uses empirical proportions (diagnostic norms) of crash types and crash attributes within congestion strata, the total number of crashes, and the number of observed crashes of a specific type to compute the cumulative probability of the observed outcome. Crash type-specific SPFs are used to identify sites at which the observed frequency or severity of specific crash types is higher than expected. This paper examines the strengths of both methods by applying them to the same datasets and comparing the results. The findings suggest that the test of proportions works well in identifying locations with a single disproportionally frequent crash type. Crash type-specific SPFs can identify locations having multiple crash types with an elevated frequency, but will not identify locations having crash patterns susceptible to correction but not having elevated counts. Findings also suggest that the degree of stratification in diagnostic norms influences the number of overlapping sites detected by both methods.
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He, Lin, Dongjie He, Yuhong Qi, Jiejing Zhou, Canliang Yuan, Hao Chang, Qiming Wang, Gaiyan Li, and Qiuju Shao. "Stereotactic Biopsy for Brainstem Lesions: A Meta-analysis with Noncomparative Binary Data." Cancer Control 28 (January 2021): 107327482110598. http://dx.doi.org/10.1177/10732748211059858.
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Objectives To evaluate the diagnostic yield and safety of brainstem stereotactic biopsy for brainstem lesions. Methods We performed a meta-analysis of English articles retrieved from the PubMed, Web of Science, Cochrane Library, and APA psycInfo databases up to May 12, 2021. A binary fixed-effect model, the inverse variance method, or a binary random-effect model, the Dersimonian Laird method, were utilized for pooling the data. This meta-analysis was registered with INPLASY, INPLASY202190034. Findings A total of 41 eligible studies with 2792 participants were included. The weighted average diagnostic yield was 97.0% (95% confidential interval [CI], 96.0-97.9%). The weighted average proportions of temporary complications, permanent deficits, and deaths were 6.2% (95% CI, 4.5–7.9%), .5% (95% CI, .2–.8%), and .3% (95% CI, .1–.5%), respectively. The subgroup analysis indicated a nearly identical weighted average diagnostic yield between MRI-guided stereotactic biopsy and CT-guided stereotactic biopsy (95.9% vs 95.8%) but slightly increased proportions of temporary complications (7.9% vs 6.0%), permanent deficits (1.9% vs .2%), and deaths (1.1% vs .4%) in the former compared to the latter. Moreover, a greater weighted average diagnostic yield (99.2% vs 97.6%) and lower proportions of temporary complications (5.1% vs 6.8%) and deaths (.7% vs 1.5%) were shown in the pediatric patient population than in the adult patient population. Conclusions Brainstem stereotactic biopsy demonstrates striking accuracy plus satisfying safety in the diagnosis of brainstem lesions. The diagnostic yield, morbidity, and mortality mildly vary based on the diversity of assistant techniques and subject populations.
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Frutos-Valle, Leixuri de, Conchita Martín, José Antonio Alarcón, Juan Carlos Palma-Fernández, Ricardo Ortega, and Alejandro Iglesias-Linares. "Novel Sub-Clustering of Class III Skeletal Malocclusion Phenotypes in a Southern European Population Based on Proportional Measurements." Journal of Clinical Medicine 9, no. 9 (September 22, 2020): 3048. http://dx.doi.org/10.3390/jcm9093048.
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Current phenotypic characterizations of Class III malocclusion are influenced more by gender or ethnic origin than by raw linear skeletal measurements. The aim of the present research is to develop a Class III skeletal malocclusion sub-phenotype characterization based on proportional cranial measurements using principal component analysis and cluster analysis. Radiometric data from 212 adult subjects (115 women and 96 men) of southern European origin affected by Class III skeletal malocclusion were analyzed. A total of 120 measurements were made, 26 were proportional skeletal measurements, which were used to perform principal component analysis and subsequent cluster analysis. The remaining 94 supplementary measurements were used for a greater description of the identified clusters. Principal component analysis established eight principal components that explained 85.1% of the total variance. The first three principal components explained 51.4% of the variance and described mandibular proportions, anterior facial height proportions, and posterior–anterior cranial proportions. Cluster analysis established four phenotypic subgroups, representing 18.4% (C1), 20.75% (C2), 38.68% (C3), and 22.17% (C4) of the sample. A new sub-clustering of skeletal Class III malocclusions that avoids gender influence is provided. Our results improve clinicians’ resources for Class III malocclusion and could improve the diagnostic and treatment approaches for this malocclusion.
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Song, Sarah, Richard E. Burgess, and Chelsea S. Kidwell. "Racial Differences by Ischemic Stroke Subtype: A Comprehensive Diagnostic Approach." Stroke Research and Treatment 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/735097.
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Background. Previous studies have suggested that black populations have more small-vessel and fewer cardioembolic strokes. We sought to analyze racial differences in ischemic stroke subtype employing a comprehensive diagnostic workup with magnetic resonance-imaging-(MRI-) based evaluation including diffusion-weighted imaging (DWI).Methods. 350 acute ischemic stroke patients admitted to an urban hospital with standardized comprehensive diagnostic evaluations were retrospectively analyzed. Ischemic stroke subtype was determined by three Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification systems.Results. We found similar proportions of cardioembolic and lacunar strokes in the black and white cohort. The only subtype category with a significant difference by race was “stroke of other etiology,” more common in whites. Black stroke patients were more likely to have an incomplete evaluation, but this did not reach significance.Conclusions. We found similar proportions by race of cardioembolic and lacunar strokes when employing a full diagnostic evaluation including DWI MRI. The relatively high rate of cardioembolism may have been underappreciated in black stroke patients when employing a CT approach to stroke subtype diagnosis. Further research is required to better understand the racial differences in frequency of “stroke of other etiology” and explore disparities in the extent of diagnostic evaluations.
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Patten, S. B., J. V. A. Williams, D. H. Lavorato, A. G. M. Bulloch, K. M. Fiest, J. L. Wang, and T. T. Sajobi. "Seasonal variation in major depressive episode prevalence in Canada." Epidemiology and Psychiatric Sciences 26, no. 2 (January 11, 2016): 169–76. http://dx.doi.org/10.1017/s2045796015001183.
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Background.The purpose of this paper is to describe variation, over the months of the year, in major depressive episode (MDE) prevalence. This is an important aspect of the epidemiological description of MDE, and one that has received surprisingly little attention in the literature. Evidence of seasonal variation in MDE prevalence has been weak and contradictory. Most studies have sought to estimate the prevalence of seasonal affective disorder using cut-points applied to scales assessing mood seasonality rather than MDE. This approach does not align with modern classification in which seasonal depression is a diagnostic subtype of major depression rather than a distinct category. Also, some studies may have lacked power to detect seasonal differences. We addressed these limitations by examining the month-specific occurrence of conventionally defined MDE and by pooling data from large epidemiological surveys to enhance precision in the analysis.Method.Data from two national survey programmes (the National Population Health Survey and the Canadian Community Health Survey) were used, providing ten datasets collected between 1996 and 2013, together including over 500,000. These studies assessed MDE using a short form version of the Composite International Diagnostic Interview (CIDI) for major depression, with one exception being a 2012 survey that used a non-abbreviated version of the CIDI. The proportion of episodes occurring in each month was evaluated using items from the diagnostic modules and statistical methods addressing complex design features of these trials. Overall month-specific pooled estimates and associated confidence intervals were estimated using random effects meta-analysis and a gradient was assessed using a meta-regression model that included a quadratic term.Results.There was considerable sampling variability when the month-specific proportions were estimated from individual survey datasets. However, across the various datasets, there was sufficient homogeneity to justify the pooling of these estimated proportions, producing large gains in precision. Seasonal variation was clearly evident in the pooled data. The highest proportion of episodes occurred in December, January and February and the lowest proportions occurred in June, July and August. The proportion of respondents reporting MDE in January was 70% higher than August, suggesting an association with implications for health policy. The pattern persisted with stratification for age group, sex and latitude.Conclusions.Seasonal effects in MDE may have been obscured by small sample sizes in prior studies. In Canada, MDE has clear seasonal variation, yet this is not addressed in the planning of services. These results suggest that availability of depression treatment should be higher in the winter than the summer months.
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Graves, Lisa V., Emily C. Edmonds, Kelsey R. Thomas, Alexandra J. Weigand, Shanna Cooper, and Mark W. Bondi. "Evidence for the Utility of Actuarial Neuropsychological Criteria Across the Continuum of Normal Aging, Mild Cognitive Impairment, and Dementia." Journal of Alzheimer's Disease 78, no. 1 (October 27, 2020): 371–86. http://dx.doi.org/10.3233/jad-200778.
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Background: Research suggests that actuarial neuropsychological criteria improve the accuracy of mild cognitive impairment (MCI) diagnoses relative to conventional diagnostic methods. Objective: We sought to examine the utility of actuarial criteria relative to consensus diagnostic methods used in the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS), and more broadly across the continuum of normal aging, MCI, and dementia. Methods: We compared rates of cognitively normal (CN), MCI, and dementia diagnoses at baseline using actuarial versus consensus diagnostic methods in 1524 individuals from the NACC UDS. Results: Approximately one-third (33.59%) of individuals diagnosed as CN and more than one-fifth (22.03%) diagnosed with dementia based on consensus methods, met actuarial criteria for MCI. Many participants diagnosed with MCI via consensus methods also appeared to represent possible diagnostic errors. Notably, the CNa/CNc group (i.e., participants diagnosed as CN based on both actuarial [a] and consensus [c] criteria) had a lower proportion of apolipoprotein E ɛ4 carriers than the MCIa/MCIc group, which in turn had a lower proportion of ɛ4 carriers than the dementia (Dem)a/Demc group. Proportions of ɛ4 carriers were comparable between the CNa/CNc and CNa/MCIc, MCIa/MCIc and MCIa/CNc, MCIa/MCIc and MCIa/Demc, and Dema/Demc and Dema/MCIc groups. These results were largely consistent with diagnostic agreement/discrepancy group comparisons on neuropsychological performance. Conclusion: The present results extend previous findings and suggest that actuarial neuropsychological criteria may enhance diagnostic accuracy relative to consensus methods, and across the wider continuum of normal aging, MCI, and dementia. Findings have implications for both clinical practice and research.
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Oliveira, Miguel, and António M. Diniz. "Perceived cost of newly prescribed medication and supplementary diagnostic tests in the elderly: An experimental approach." Análise Psicológica 40, no. 1 (June 14, 2022): 65–79. http://dx.doi.org/10.14417/ap.1886.
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Primary nonadherence to medical prescription is a notorious phenomenon among the elderly. The perceived cost of medication and supplementary diagnostic tests is a major factor driving prescription adherence decisions. To explore the way such factor impinges on the perception of prescription cost, two independent samples of elderly volunteers (medication, N=59; supplementary diagnostic tests, N=58) rated on a visual analogue scale specific amounts of money matching three proportions of income reduction of a fictitious patient. Both medication and supplementary diagnostic tests modalities of prescription showed participants’ perception of cost to notoriously vary in the 3% and the 30% proportions of prescription values to the fictitious patient’s income, but not in the 15%. Further, Different patterns of perceived cost response suggest that an element of intertemporal choice influenced cost perception. Participants’ income had had no impact on their perception of cost, contrary to the pattern of self-referent responses that “perspective-taking” approaches would suggest. Further, research would benefit from broadening these experimental settings to include other known factors impacting nonadherence along with cost.
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McLaughlin, Katie A., Anne M. Gadermann, Irving Hwang, Nancy A. Sampson, Ali Al-Hamzawi, Laura Helena Andrade, Matthias C. Angermeyer, et al. "Parent psychopathology and offspring mental disorders: Results from the WHO World Mental Health Surveys." British Journal of Psychiatry 200, no. 4 (April 2012): 290–99. http://dx.doi.org/10.1192/bjp.bp.111.101253.
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BackgroundAssociations between specific parent and offspring mental disorders are likely to have been overestimated in studies that have failed to control for parent comorbidity.AimsTo examine the associations of parent with respondent disorders.MethodData come from the World Health Organization (WHO) World Mental Health Surveys (n = 51 507). Respondent disorders were assessed with the Composite International Diagnostic Interview and parent disorders with informant-based Family History Research Diagnostic Criteria interviews.ResultsAlthough virtually all parent disorders examined (major depressive, generalised anxiety, panic, substance and antisocial behaviour disorders and suicidality) were significantly associated with offspring disorders in multivariate analyses, little specificity was found. Comorbid parent disorders had significant sub-additive associations with offspring disorders. Population-attributable risk proportions for parent disorders were 12.4% across all offspring disorders, generally higher in high- and upper-middle- than low-/lower-middle-income countries, and consistently higher for behaviour (11.0–19.9%) than other (7.1–14.0%) disorders.ConclusionsParent psychopathology is a robust non-specific predictor associated with a substantial proportion of offspring disorders.
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Sorelli, Paolo G., Alex D. Iliadis, and John G. Payne. "The Effectiveness of a Rapid-Access Flexible Sigmoidoscopy Clinic in a District Hospital." International Surgery 99, no. 4 (July 1, 2014): 374–78. http://dx.doi.org/10.9738/intsurg-d-13-00096.1.
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Abstract Historically rapid-access colorectal clinics have had high proportions of nonconforming referrals from primary care physicians, which calls into question the clinics' efficacy. We aim to determine the effectiveness of our rapid-access flexible sigmoidoscopy clinic, and the adherence to the referral guidelines for suspected bowel cancer by general practitioners. We performed a 3-month retrospective audit to evaluate (1) the proportion of patients seen within 2 weeks, (2) the appropriateness of referrals, (3) the proportion of patients with findings, and (4) the proportion of patients who had further tests. A total of 59 patients (19 male, 40 female; age 35–86 years) were included in the study. All were offered an appointment within 2 weeks. Forty-one cases (82%) were appropriate referrals. Twenty-eight patients (47%) had pathology at sigmoidoscopy. Cancer pick-up rate was 6%. Thirty-seven patients (74%) had further investigations. We determined that our rapid-access clinic for symptomatic patients has high diagnostic accuracy and that access to early investigation is being used appropriately by general practitioners. In the current climate of spending cuts and streamlining services, our study confirms we are meeting targets for delivery of our colorectal service. The majority of referrals under the 2-week rule are appropriate. Rapid access to early investigation is being used appropriately by general practitioners contrasting previous studies with high proportions of nonconforming referrals.
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Karihtala, Kristiina, Suvi-Katri Leivonen, Oscar Brück, Marja-Liisa Karjalainen-Lindsberg, Satu Mustjoki, Teijo Pellinen, and Sirpa Leppä. "Prognostic Impact of Tumor-Associated Macrophages on Survival Is Checkpoint Dependent in Classical Hodgkin Lymphoma." Cancers 12, no. 4 (April 4, 2020): 877. http://dx.doi.org/10.3390/cancers12040877.
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Tumor microenvironment and immune escape affect pathogenesis and survival in classical Hodgkin lymphoma (cHL). While tumor-associated macrophage (TAM) content has been associated with poor outcomes, macrophage-derived determinants with clinical impact have remained undefined. Here, we have used multiplex immunohistochemistry and digital image analysis to characterize TAM immunophenotypes with regard to expression of checkpoint molecules programmed cell death ligand 1 (PD-L1) and indoleamine 2,3-dioxygenase 1 (IDO-1) from the diagnostic tumor tissue samples of 130 cHL patients, and correlated the findings with clinical characteristics and survival. We show that a large proportion of TAMs express PD-L1 (CD68+, median 32%; M2 type CD163+, median 22%), whereas the proportion of TAMs expressing IDO-1 is lower (CD68+, median 5.5%; CD163+, median 1.4%). A high proportion of PD-L1 and IDO-1 expressing TAMs from all TAMs (CD68+), or from CD163+ TAMs, is associated with inferior outcome. In multivariate analysis with age and stage, high proportions of PD-L1+ and IDO-1+ TAMs remain independent prognostic factors for freedom from treatment failure (PD-L1+CD68+/CD68+, HR = 2.63, 95% CI 1.17–5.88, p = 0.019; IDO-1+CD68+/CD68+, HR = 2.48, 95% CI 1.03–5.95, p = 0.042). In contrast, proportions of PD-L1+ tumor cells, all TAMs or PD-L1− and IDO-1− TAMs are not associated with outcome. The findings implicate that adverse prognostic impact of TAMs is checkpoint-dependent in cHL.
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Yansane, A., O. Tokede, J. White, J. Etolue, L. McClellan, M. Walji, E. Obadan-Udoh, and E. Kalenderian. "Utilization and Validity of the Dental Diagnostic System over Time in Academic and Private Practice." JDR Clinical & Translational Research 4, no. 2 (December 8, 2018): 143–50. http://dx.doi.org/10.1177/2380084418815150.
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Introduction: To fill the void created by insufficient dental terminologies, a multi-institutional workgroup was formed among members of the Consortium for Oral Health Research and Informatics to develop the Dental Diagnostic System (DDS) in 2009. The adoption of dental diagnosis terminologies by providers must be accompanied by rigorous usability and validity assessments to ensure their effectiveness in practice. Objectives: The primary objective of this study was to describe the utilization and correct use of the DDS over a 4-y period. Methods: Electronic health record data were amassed from 2013 to 2016 where diagnostic terms and Current Dental Terminology procedure code pairs were adjudicated by calibrated dentists. With the resultant data, we report on the 4-y utilization and validity of the DDS at 5 dental institutions. Utilization refers to the proportion of instances that diagnoses are documented in a structured format, and validity is defined as the frequency of valid pairs divided by the number of all treatment codes entered. Results: Nearly 10 million procedures ( n = 9,946,975) were documented at the 5 participating institutions between 2013 and 2016. There was a 1.5-fold increase in the number of unique diagnoses documented during the 4-y period. The utilization and validity proportions of the DDS had statistically significant increases from 2013 to 2016 ( P < 0.0001). Academic dental sites were more likely to document diagnoses associated with orthodontic and restorative procedures, while the private dental site was equally likely to document diagnoses associated with all procedures. Overall, the private dental site had significantly higher utilization and validity proportions than the academic dental sites. Conclusion: The results demonstrate an improvement in utilization and validity of the DDS terminology over time. These findings also yield insight into the factors that influence the usability, adoption, and validity of dental terminologies, raising the need for more focused training of dental students. Knowledge Transfer Statement: Ensuring that providers use standardized methods for documentation of diagnoses represents a challenge within dentistry. The results of this study can be used by clinicians when evaluating the utility of diagnostic terminologies embedded within the electronic health record.
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Broos, Caroline E., Laura L. Koth, Menno van Nimwegen, Johannes C. C. M. in ‘t Veen, Sandra M. J. Paulissen, Jan Piet van Hamburg, Jouke T. Annema, et al. "Increased T-helper 17.1 cells in sarcoidosis mediastinal lymph nodes." European Respiratory Journal 51, no. 3 (February 15, 2018): 1701124. http://dx.doi.org/10.1183/13993003.01124-2017.
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The lung-draining mediastinal lymph nodes (MLNs) are currently widely used to diagnose sarcoidosis. We previously reported that T-helper (Th) 17.1 cells are responsible for the exaggerated interferon-γ production in sarcoidosis lungs. In this study, we aimed to investigate 1) whether Th17.1 cells are also increased in the MLNs of sarcoidosis patients and 2) whether frequencies of the Th17.1 cells at diagnosis may correlate with disease progression.MLN cells from treatment-naive pulmonary sarcoidosis patients (n=17) and healthy controls (n=22) and peripheral blood mononuclear cells (n=34) and bronchoalveolar lavage fluid (BALF) (n=36) from sarcoidosis patients were examined for CD4+ T-cell subset proportions using flow cytometry.Higher proportions of Th17.1 cells were detected in sarcoidosis MLNs than in control MLNs. Higher Th17.1 cell proportions were found in sarcoidosis BALF compared with MLNs and peripheral blood. Furthermore, BALF Th17.1 cell proportions were significantly higher in patients developing chronic disease than in patients undergoing resolution within 2 years of clinical follow-up.These data suggest that Th17.1 cell proportions in pulmonary sarcoidosis can be evaluated as a diagnostic and/or prognostic marker in clinical practice and could serve as a new therapeutic target.
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Murphy, Daniel R., Louis Wu, Eric J. Thomas, Samuel N. Forjuoh, Ashley N. D. Meyer, and Hardeep Singh. "Electronic Trigger-Based Intervention to Reduce Delays in Diagnostic Evaluation for Cancer: A Cluster Randomized Controlled Trial." Journal of Clinical Oncology 33, no. 31 (November 1, 2015): 3560–67. http://dx.doi.org/10.1200/jco.2015.61.1301.
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Purpose We tested whether prospective use of electronic health record-based trigger algorithms to identify patients at risk of diagnostic delays could prevent delays in diagnostic evaluation for cancer. Methods We performed a cluster randomized controlled trial of primary care providers (PCPs) at two sites to test whether triggers that prospectively identify patients with potential delays in diagnostic evaluation for lung, colorectal, or prostate cancer can reduce time to follow-up diagnostic evaluation. Intervention steps included queries of the electronic health record repository for patients with abnormal findings and lack of associated follow-up actions, manual review of triggered records, and communication of this information to PCPs via secure e-mail and, if needed, phone calls to ensure message receipt. We compared times to diagnostic evaluation and proportions of patients followed up between intervention and control cohorts based on final review at 7 months. Results We recruited 72 PCPs (36 in the intervention group and 36 in the control group) and applied the trigger to all patients under their care from April 20, 2011, to July 19, 2012. Of 10,673 patients with abnormal findings, the trigger flagged 1,256 patients (11.8%) as high risk for delayed diagnostic evaluation. Times to diagnostic evaluation were significantly lower in intervention patients compared with control patients flagged by the colorectal trigger (median, 104 v 200 days, respectively; n = 557; P < .001) and prostate trigger (40% received evaluation at 144 v 192 days, respectively; n = 157; P < .001) but not the lung trigger (median, 65 v 93 days, respectively; n = 19; P = .59). More intervention patients than control patients received diagnostic evaluation by final review (73.4% v 52.2%, respectively; relative risk, 1.41; 95% CI, 1.25 to 1.58). Conclusion Electronic trigger-based interventions seem to be effective in reducing time to diagnostic evaluation of colorectal and prostate cancer as well as improving the proportion of patients who receive follow-up. Similar interventions could improve timeliness of diagnosis of other serious conditions.
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Nam, Jiho, Jun-Su Jang, Honggie Kim, Jong Yeol Kim, and Jun-Hyeong Do. "Modification of the Integrated Sasang Constitutional Diagnostic Model." Evidence-Based Complementary and Alternative Medicine 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/9180159.
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In 2012, the Korea Institute of Oriental Medicine proposed an objective and comprehensive physical diagnostic model to address quantification problems in the existing Sasang constitutional diagnostic method. However, certain issues have been raised regarding a revision of the proposed diagnostic model. In this paper, we propose various methodological approaches to address the problems of the previous diagnostic model. Firstly, more useful variables are selected in each component. Secondly, the least absolute shrinkage and selection operator is used to reduce multicollinearity without the modification of explanatory variables. Thirdly, proportions of SC types and age are considered to construct individual diagnostic models and classify the training set and the test set for reflecting the characteristics of the entire dataset. Finally, an integrated model is constructed with explanatory variables of individual diagnosis models. The proposed integrated diagnostic model significantly improves the sensitivities for both the male SY type (36.4% → 62.0%) and the female SE type (43.7% → 64.5%), which were areas of limitation of the previous integrated diagnostic model. The ideas of these new algorithms are expected to contribute not only to the scientific development of Sasang constitutional medicine in Korea but also to that of other diagnostic methods for traditional medicine.
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Downie, Aron, Mark Hancock, Hazel Jenkins, Rachelle Buchbinder, Ian Harris, Martin Underwood, Stacy Goergen, and Chris G. Maher. "How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years." British Journal of Sports Medicine 54, no. 11 (February 13, 2019): 642–51. http://dx.doi.org/10.1136/bjsports-2018-100087.
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ObjectivesTo (1) estimate the proportion of patients seeking care for low back pain (LBP) who are imaged and (2) explore trends in the proportion of patients who received diagnostic imaging over time. We also examined the effect of study-level factors on estimates of imaging proportion.Data sourcesElectronic searches of MEDLINE, Embase and CINAHL databases from January 1995 to December 2017.Eligibility criteria for selecting studiesObservational designs and controlled trials that reported imaging for patients presenting to primary care or emergency care for LBP. We assessed study quality and calculated pooled proportions by care setting and imaging type, with strength of evidence assessed using the GRADE system.Results45 studies were included. They represented 19 451 749 consultations for LBP that had resulted in 4 343 919 imaging requests/events over 21 years. Primary care: moderate quality evidence that simple imaging proportion was 16.3% (95% CI 12.6% to 21.1%) and complex imaging was 9.2% (95% CI 6.2% to 13.5%). For any imaging, the pooled proportion was 24.8% (95% CI 19.3%to 31.1%). Emergency care: moderate quality evidence that simple imaging proportion was 26.1% (95% CI 18.2% to 35.8%) and high-quality evidence that complex imaging proportion was 8.2% (95% CI 4.4% to 15.6%). For any imaging, the pooled proportion was 35.6% (95% CI 29.8% to 41.8%). Complex imaging increased from 7.4% (95% CI 5.7% to 9.6%) for imaging requested in 1995 to 11.4% (95% CI 9.6% to 13.5%) in 2015 (relative increase of 53.5%). Between-study variability in imaging proportions was only partially explained by study-level characteristics; there were insufficient data to comment on some prespecified study-level factors.Summary/conclusionOne in four patients who presented to primary care with LBP received imaging as did one in three who presented to the emergency department. The rate of complex imaging appears to have increased over 21 years despite guideline advice and education campaigns.Trial registration numberCRD42016041987.
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Pickett, William, Atif Kukaswadia, Wendy Thompson, Mylene Frechette, Steven McFaull, Hilary Dowdall, and Robert J. Brison. "Use of diagnostic imaging in the emergency department for cervical spine injuries in Kingston, Ontario." CJEM 16, no. 01 (January 2014): 25–33. http://dx.doi.org/10.2310/8000.2013.131051.
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ABSTRACTObjectives:This study assessed the use and clinical yield of diagnostic imaging (radiography, computed tomography, and medical resonance imaging) ordered to assist in the diagnosis of acute neck injuries presenting to emergency departments (EDs) in Kingston, Ontario, from 2002–2003 to 2009–2010.Methods:Acute neck injury cases were identified using records from the Kingston sites of the Canadian National Ambulatory Care Reporting System. Use of radiography was analyzed over time and related to proportions of cases diagnosed with clinically significant cervical spine injuries.Results:A total of 4,712 neck injury cases were identified. Proportions of cases referred for diagnostic imaging to the neck varied significantly over time, from 30.4% in 2002–2003 to 37.6% in 2009–2010 (ptrend= 0.02). The percentage of total cases that were positive for clinically significant cervical spine injury (“clinical yield”) also varied from a low of 5.8% in 2005–2006 to 9.2% in 2008–2009 (ptrend= 0.04), although the clinical yield of neck-imaged cases did not increase across the study years (ptrend= 0.23). Increased clinical yield was not observed in association with higher neck imaging rates whether that yield was expressed as a percentage of total cases positive for clinically significant injury (p= 0.29) or as a percentage of neck-imaged cases that were positive (p= 0.77).Conclusions:We observed increases in the use of diagnostic images over time, reflecting a need to reinforce an existing clinical decision rule for cervical spine radiography. Temporal increases in the clinical yield for total cases may suggest a changing case mix or more judicious use of advanced types of diagnostic imaging.
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Fedyanina, O. S., Yu Yu Chuksina, A. N. Khmelevskaya, A. N. Khvastunova, Yu N. Matveev, E. V. Kataeva, A. V. Filatov, and S. A. Kuznetsova. "Diagnostic criteria of lymphoproliferative diseases from the peripheral blood samples using a cell biochip." Almanac of Clinical Medicine 49, no. 6 (November 24, 2021): 405–11. http://dx.doi.org/10.18786/2072-0505-2021-49-053.
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Background: At present, the diagnosis of lymphoproliferative disorders is based on the combination of blood or bone marrow smear morphology and immunophenotyping by flow cytometry. Immunophenotypic testing by flow cytometry technique is available only in big medical centers, which is not always convenient for a patient. Therefore, development of an available method for preliminary diagnosis of lymphoproliferative diseases not requiring special equipment seems relevant.Materials and methods: Peripheral blood mononuclear cells from 17 patients admitted to the hospital with suspicion of a lymphoproliferative disorder, and 17 healthy donors were studied on a cell biochip for determination of proportions of cells positive for various surface CD antigens. The diagnosis was verified by flow cytometry.Results: Compared to healthy controls and patients with T-cell lymphoproliferative disorders (TCLPD), the patients with B-cell lymphoproliferative disorders (BCLPD) had significantly lower proportion of CD7+ cells (medians, 7% and 73% respectively, p=2×10-6 for comparison with healthy controls; median 7% and 93% for comparison with TCLPD, p=0.032). In addition, the patients with BCLPD had higher proportion of peripheral СD19+ mononuclear cells, compared to that in the patients with TCLPD and healthy donors (medians 84% and 13% for comparison between BCLPD and healthy control, p=2×10-5; 84% and 3% for comparison of BCLPD and TCLPD, p=0.033). The patients with B-cell chronic lymphocytic leukemia had significantly higher CD5+ cells in the cell biochip compared to the patients with other BCLPD (medians 72% and 9%, p=0.024). The patients with TCLPD had significantly lower proportion of CD19+ cells than the healthy controls (medians, 3% and 13%, respectively, р=0.042).Conclusion: The study has demonstrated the potential to use the previously developed cell biochip for diagnosis of lymphoproliferative diseases. The biochip makes it possible to sort out white blood cells according to their surface differentiation antigen for their further morphological analysis. The cell biochip allows for the differential diagnosis between BCLPD and TCLPD and determination the lymphocyte clones based on the expression of immunoglobulin light chains.
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Salika, Theodosia, Gary A. Abel, Silvia C. Mendonca, Christian von Wagner, Cristina Renzi, Annie Herbert, Sean McPhail, and Georgios Lyratzopoulos. "Associations between diagnostic pathways and care experience in colorectal cancer: evidence from patient-reported data." Frontline Gastroenterology 9, no. 3 (April 20, 2018): 241–48. http://dx.doi.org/10.1136/flgastro-2017-100926.
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ObjectiveTo examine how different pathways to diagnosis of colorectal cancer may be associated with the experience of subsequent care.DesignPatient survey linked to information on diagnostic route.English patients with colorectal cancer (analysis sample n=6837) who responded to a patient survey soon after their hospital treatment.Main outcome measuresOdds Ratios and adjusted proportions of negative evaluation of key aspects of care for colorectal cancer, including the experience of shared decision-making about treatment, specialist nursing and care coordination, by diagnostic route (ie, screening detection, emergency presentation, urgent and elective general practitioner referral).ResultsFor 14 of 18 questions, there was evidence (p≤0.02) for variation in patient experience by diagnostic route, with 6–31 percentage point differences between routes in adjusted proportions of negative experience. Emergency presenters were more likely to report a negative experience for most questions, including those about adequacy of information about their diagnosis and sufficient explanation before operations. Screen-detected patients were least likely to report negative experiences except for support from primary care. Patients diagnosed through elective primary care referrals were most likely to report worse experience for questions for which overall variation by route was generally small.ConclusionsScreening-detected patients tend to report the best and emergency presenters the worst experience of subsequent care. Improvement efforts can target care integration for screening-detected patients and provision of information about the diagnosis and treatment of emergency presenters.
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Ratnayake, Chathri, Ramja Kokulan, and Patrick Carney. "115 Is MBS restriction on EEGs truly beneficial? Retrospective observational analysis of EEG referral patterns." Journal of Neurology, Neurosurgery & Psychiatry 90, e7 (July 2019): A37.2—A37. http://dx.doi.org/10.1136/jnnp-2019-anzan.102.
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IntroductionThe November 2018 Medicare Benefits Schedule (MBS) Taskforce draft report recommends standardised national referral form for routine electroencephalogram (EEG) requests to prevent low value clinician referrals. MBS defines twelve clinical presentations where routine EEG is of relatively low diagnostic value. We aim to identify proportion of MBS defined low diagnostic value EEGs and likely referral patterns.MethodsRetrospective single centre observational study was conducted from January to December 2018. All EEG referrals to a tertiary hospital neurodiagnostic unit were categorised as low or high yield based on MBS recommendation. Sub-group analysis of the low yield group was carried out.ResultsTotal of 1210 EEG referrals were analysed and 5 were excluded from analysis due to insufficient clinical data. Of these referrals 1114 (92.4%) were for high yield indications, 77 (6.4%) for low yield and 14 (1.2%) were indeterminate as to low or high value. Of low yield referrals, 70% were referred for syncope or presyncope and 18.2% for psychogenic nonepileptic seizures. Low yield EEGs were referred by hospital doctors, neurologists and general partitioners by proportions of 37.7%, 33.7% and 28.6% respectively. Four (5.2%) low diagnostic value EEGs were abnormal.ConclusionCurrent clinical practice for EEG referrals is in line with MBS draft review recommendations. We believe addition of a standardised referral form and restricting referrals will have minimal impact on referral quality.
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Divala, T. H., J. Lewis, M. A. Bulterys, V. Lutje, E. L. Corbett, S. G. Schumacher, and P. MacPherson. "Missed opportunities for diagnosis and treatment in patients with TB symptoms: a systematic review." Public Health Action 12, no. 1 (March 21, 2022): 10–17. http://dx.doi.org/10.5588/pha.21.0022.
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BACKGROUND: The identification of patients with symptoms is the foundation of facility-based TB screening and diagnosis, but underdiagnosis is common. We conducted this systematic review with the hypothesis that underdiagnosis is largely secondary to patient drop out along the diagnostic and care pathway.METHODS: We searched (up to 22 January 2019) MEDLINE, Embase, and Cinahl for studies investigating patient pathway to TB diagnosis and care at health facilities. We used Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) to assess risk of bias. We reported proportions of patients with symptoms at each stage of the pathway from symptom screening to treatment initiation.RESULTS: After screening 3,558 abstracts, we identified 16 eligible studies. None provided data addressing the full cascade of care from clinical presentation to treatment initiation in the same patient population. Symptom screening, the critical entry point for diagnosis of TB, was not done for 33–96% of participants with symptoms in the three studies that reported this outcome. The proportion of attendees with symptoms offered a diagnostic investigation (data available for 15 studies) was very low with a study level median of 38% (IQR 14–44, range 4–84)CONCLUSIONS: Inefficiencies of the TB symptom screen-based patient pathway are a major contributor to underdiagnosis of TB, reflecting inconsistent implementation of guidelines to ask all patients attending health facilities about respiratory symptoms and to offer diagnostic tests to all patients promptly once TB symptoms are identified. Better screening tools and interventions to improve the efficiency of TB screening and diagnosis pathways in health facilities are urgently needed.
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Chinnakali, Palanivel, Kalaiselvi Selvaraj, Pruthu Thekkur, Gomathi Ramasamy, Mahalakshmy Thulasingam, and Kavita Vasudevan. "Age and Sex Differences in Sputum Smear Microscopy Results for Acid Fast Bacilli in a Tertiary Care Centre, South India." Journal of Respiratory Medicine 2014 (November 9, 2014): 1–5. http://dx.doi.org/10.1155/2014/674942.
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Background and Objectives. Low counts are more difficult to find in microscopic sputum examination and thus are more likely to be missed. In this study, we aimed to estimate the proportion of low-count grading and assessing any age and gender differences in sputum smear grading in a low HIV prevalence setting. Materials and Methods. From the tuberculosis laboratory register information on sputum positivity including the grading of smears, age and gender were extracted for January 2011–December 2011. Smears were examined using Ziehl-Neelsen technique and graded as per the Program Guidelines. Positive smears were classified into low grade positive smears (scanty and 1+) and high grade positive smears (2+ and 3+). Differences in grading of smear based on gender and age were analysed using chi square test. Results. Of 9000 smears examined, 8210 (91.2%) were collected as diagnostic smears from tuberculosis suspects. Low grade positivity was 37.5% among diagnostic smears and 69.6% among follow-up smears. Sputum smears from female examinees had higher proportions of low grade positive smears (P=0.003). Stratification of age and sex within TB suspects had clearly demonstrated the observance of higher low grade positivity among female TB suspects at extremes of age.
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Saeki, Hiroyuki, and Toshiro Tango. "Non-inferiority test and confidence interval for the difference in correlated proportions in diagnostic procedures based on multiple raters." Statistics in Medicine 30, no. 28 (September 22, 2011): 3313–27. http://dx.doi.org/10.1002/sim.4364.
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Abdul-Ghani, Rashad, Mohammed A. K. Mahdy, Sameer Alkubati, Abdullah A. Al-Mikhlafy, Abdullah Alhariri, Mrinalini Das, Kapilkumar Dave, and Julita Gil-Cuesta. "Malaria and dengue in Hodeidah city, Yemen: High proportion of febrile outpatients with dengue or malaria, but low proportion co-infected." PLOS ONE 16, no. 6 (June 25, 2021): e0253556. http://dx.doi.org/10.1371/journal.pone.0253556.
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Background The emergence of dengue in malaria-endemic countries with limited diagnostic resources, such as Yemen, can be problematic because presumptive treatment of febrile cases as being malaria is a common practice. Co-infections with dengue and malaria are often overlooked and misdiagnosed as being a mono-infection because of clinical similarities. In Hodeidah city, Yemen, the capacity to conduct the diagnosis can be aggravated by the war context. To assess the magnitude of the problem, we determined the proportions of malaria, dengue and co-infection in relation to clinical characteristics among febrile outpatients. Methods This cross-sectional study included 355 febrile outpatients from Hodeidah city during the malaria transmission season (September 2018 –February 2019). Sociodemographic and clinical characteristics were collected using a pre-designed, structured questionnaire. Malaria was confirmed using microscopy and rapid diagnostic tests (RDTs), while dengue was confirmed using RDTs. Results Mono-infection proportions of 32.4% for falciparum malaria and 35.2% for dengue were found, where about two-thirds of dengue patients had a recent probable infection. However, co-infection with falciparum malaria and dengue was detected among 4.8% of cases. There was no statistically significant difference between having co-infection and mono-infection with malaria or dengue in relation to the sociodemographic characteristics. On the other hand, the odds of co-infection were significantly lower than the odds of malaria among patients presenting with sweating (OR = 0.1, 95% CI: 0.05–0.45; p <0.001), while the odds of co-infection were 3.5 times significantly higher than the odds of dengue among patients presenting with vomiting (OR = 3.5, 95% CI: 1.20–10.04; p <0.021). However, there were no statistically significant differences between having co-infection and mono-infection (malaria or dengue) in relation to other clinical characteristics. Conclusions Mono-infection with malaria or dengue can be detected among about one-third of febrile outpatients in Hodeidah, while almost 5.0% of cases can be co-infected. Sociodemographic and clinical characteristics cannot easily distinguish malaria patients from dengue-infected or co-infected ones, reinforcing the necessity of laboratory confirmation and avoidance of treating febrile patients as being presumed malaria cases.
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Wanderley, Miriam, Lara Pereira, Carla Santos, Vinícius Cunha, and Mariam Neves. "Association between Insulin Resistance and Cardiovascular Risk Factors in Polycystic Ovary Syndrome Patients." Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics 40, no. 04 (April 2018): 188–95. http://dx.doi.org/10.1055/s-0038-1642634.
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Objective To analyze the association between the indirect methods of evaluating insulin resistance (IR) and blood pressure, anthropometric and biochemical parameters in a population of polycystic ovary syndrome (PCOS) patients. Methods Cross-sectional study performed at the Hospital Universitário de Brasília (HUB, in the Portuguese acronym) involving PCOS patients diagnosed from January 2011 to January 2013. Four indirect methods, namely, fasting blood insulin level, fasting glucose/insulin ratio (G/I), homeostatic model-assessment-insulin resistance (HOMA-IR), and the quantitative insulin sensitivity check index (QUICKI), were used to obtain the IR diagnosis. The data were analyzed using the test of proportions, the Chi-square test, and Fisher exact test, when indicated. Results Out of the 83 patients assessed, aged 28.79 ± 5.85, IR was found in 51.81–66.2% of them using the G/I ratio and the QUICKI, respectively. The test of proportions did not show a significant difference between the methods analyzed. The proportion of IR diagnoses was statistically higher in obese women than in women with normal body mass index (BMI). We observed a statistically significant association between all the methods for diagnosing IR and BMI, waist circumference (WC) and lipid accumulation product (LAP). With regards to arterial hypertension (AH), we observed a significant association according to three methods, with the exception of the ratio G/I. Conclusion Insulin resistance prevalence varied according to the diagnostic method employed, with no statistical difference between them. The proportion of IR diagnoses was statistically higher in obese women than in women with normal BMI. We observed a significant association between IR and WC, BMI, LAP, as well as dyslipidemia and AH in a high proportion of patients.
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Brenner, Hermann, and Agne Krilaviciute. "Commonly Applied Selection Criteria for Lung Cancer Screening May Have Strongly Varying Diagnostic Performance in Different Countries." Cancers 12, no. 10 (October 16, 2020): 3012. http://dx.doi.org/10.3390/cancers12103012.
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Lung cancer (LC) screening often focuses heavy smokers as a target for screening group. Heavy smoking can thus be regarded as an LC pre-screening test with sensitivities and specificities being different in various populations due to the differences in smoking histories. We derive here expected sensitivities and specificities of various criteria to preselect individuals for LC screening in 27 European countries with diverse smoking prevalences. Sensitivities of various heavy-smoking-based pre-screening criteria were estimated by combining sex-specific proportions of people meeting these criteria in the target population for screening with associations of heavy smoking with LC risk. Expected specificities were approximated by the proportion of individuals not meeting the heavy smoking definition. Estimated sensitivities and specificities varied widely across countries, with sensitivities being generally higher among men (range: 33–80%) than among women (range: 9–79%), and specificities being generally lower among men (range: 48–90%) than among women (range: 70–99%). Major variation in sensitivities and specificities was also seen across different pre-selection criteria for LC screening within individual countries. Our results may inform the design of LC screening programs in European countries and serve as benchmarks for novel alternative or complementary tests for selecting people at high risk for CT-based LC screening.
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Khaitov, Vadim, Julia Marchenko, Marina Katolikova, Risto Väinölä, Sarah E. Kingston, David B. Carlon, Michael Gantsevich, and Petr Strelkov. "Species identification based on a semi-diagnostic marker: Evaluation of a simple conchological test for distinguishing blue mussels Mytilus edulis L. and M. trossulus Gould." PLOS ONE 16, no. 7 (July 23, 2021): e0249587. http://dx.doi.org/10.1371/journal.pone.0249587.
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Cryptic and hybridizing species may lack diagnostic taxonomic characters leaving researchers with semi-diagnostic ones. Identification based on such characters is probabilistic, the probability of correct identification depending on the species composition in a mixed population. Here we test the possibilities of applying a semi-diagnostic conchological character for distinguishing two cryptic species of blue mussels, Mytilus edulis and M. trossulus. These ecologically, stratigraphically and economically important molluscs co-occur and hybridize in many areas of the North Atlantic and the neighboring Arctic. Any cues for distinguishing them in sympatry without genotyping would save much research effort. Recently these species have been shown to statistically differ in the White Sea, where a simple character of the shell was used to distinguish two mussel morphotypes. In this paper, we analyzed the associations between morphotypes and species-specific genotypes based on an abundant material from the waters of the Kola Peninsula (White Sea, Barents Sea) and a more limited material from Norway, the Baltic Sea, Scotland and the Gulf of Maine. The performance of the “morphotype test” for species identification was formally evaluated using approaches from evidence-based medicine. Interspecific differences in the morphotype frequencies were ubiquitous and unidirectional, but their scale varied geographically (from 75% in the White Sea to 15% in the Baltic Sea). In addition, salinity-related variation of this character within M. edulis was revealed in the Arctic Barents Sea. For every studied region, we established relationships between the proportions of the morphotypes in the populations as well as between the proportions of the morphotypes in samples and the probabilities of mussels of different morphotypes being M. trossulus and M. edulis. We provide recommendations for the application of the morphotype test to mussels from unstudied contact zones and note that they may apply equally well to other taxa identified by semi-diagnostic traits.
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Hemelaar, Joris, Shanghavie Loganathan, Ramyiadarsini Elangovan, Jason Yun, Leslie Dickson-Tetteh, and Shona Kirtley. "Country Level Diversity of the HIV-1 Pandemic between 1990 and 2015." Journal of Virology 95, no. 2 (October 21, 2020): e01580-20. http://dx.doi.org/10.1128/jvi.01580-20.
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ABSTRACTThe global diversity of HIV forms a major challenge to the development of an HIV vaccine, as well as diagnostic, drug resistance, and viral load assays, which are essential to reaching the UNAIDS 90:90:90 targets. We sought to determine country level HIV-1 diversity globally between 1990 and 2015. We assembled a global HIV-1 molecular epidemiology database through a systematic literature search and a global survey. We searched PubMed, EMBASE (Ovid), CINAHL (Ebscohost), and Global Health (Ovid) for HIV-1 subtyping studies published from 1 January 1990 to 31 December 2015. We collected additional unpublished data through a global survey of experts. Prevalence studies with original HIV-1 subtyping data collected between 1990 and 2015 were included. This resulted in a database with 383,519 subtyped HIV-1 samples from 116 countries over four time periods (1990 to 1999, 2000 to 2004, 2005 to 2009, and 2010 to 2015). We analyzed country-specific numbers of distinct HIV-1 subtypes, circulating recombinant forms (CRFs), and unique recombinant forms (URFs) in each time period. We also analyzed country-specific proportions of infections due to HIV-1 recombinants, CRFs, and URFs and calculated the Shannon diversity index for each country. Finally, we analyzed global temporal trends in each of these measures of HIV-1 diversity. We found extremely wide variation in complexity of country level HIV diversity around the world. Central African countries such as Chad, Democratic Republic of the Congo, Angola, and Republic of the Congo have the most diverse HIV epidemics. The number of distinct HIV-1 subtypes and recombinants was greatest in Western Europe (Spain and France) and North America (United States) (up to 39 distinct HIV-1 variants in Spain). The proportion of HIV-1 infections due to recombinants was highest in Southeast Asia (>95% of infections in Viet Nam, Cambodia, and Thailand), China, and West and Central Africa, mainly due to high proportions of CRF01_AE and CRF02_AG. Other CRFs played major roles (>75% of HIV-1 infections) in Estonia (CRF06_cpx), Iran (CRF35_AD), and Algeria (CRF06_cpx). The highest proportions of URFs (>30%) were found in Myanmar, Republic of the Congo, and Argentina. Global temporal analysis showed consistent increases over time in country level numbers of distinct HIV-1 variants and proportions of CRFs and URFs, leading to increases in country level HIV-1 diversity. Our study provides epidemiological evidence that the HIV pandemic is diversifying at country level and highlights the increasing challenge to prevention and treatment efforts. HIV-1 molecular epidemiological surveillance needs to be continued and improved.IMPORTANCE This is the first study to analyze global country level HIV-1 diversity from 1990 to 2015. We found extremely wide variation in complexity of country level HIV diversity around the world. Central African countries have the most diverse HIV epidemics. The number of distinct HIV-1 subtypes and recombinants was greatest in Western Europe and North America. The proportion of HIV-1 infections due to recombinants was highest in South-East Asia, China, and West and Central Africa. The highest proportions of URFs were found in Myanmar, Republic of the Congo, and Argentina. Our study provides epidemiological evidence that the HIV pandemic is diversifying at country level and highlights the increasing challenge to HIV vaccine development and diagnostic, drug resistance, and viral load assays.
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Yim, Younghee, Seung Chai Jung, Jung Youn Kim, Seon-Ok Kim, Byung Jun Kim, Deok Hee Lee, Wonhyoung Park, Jung Cheol Park, and Jae Sung Ahn. "Added diagnostic values of three-dimensional high-resolution proton density-weighted magnetic resonance imaging for unruptured intracranial aneurysms in the circle-of-Willis: Comparison with time-of-flight magnetic resonance angiography." PLOS ONE 15, no. 12 (December 3, 2020): e0243235. http://dx.doi.org/10.1371/journal.pone.0243235.
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Background Advanced imaging methods can enhance the identification of aneurysms of the infundibula, which can reduce unnecessary follow-ups or further work-up, fear, and anxiety in patients. Purpose This study aimed to evaluate the added diagnostic value of three-dimensional proton density-weighted vessel wall magnetic resonance imaging (3D-PD MRI) in identifying aneurysms from index lesions refer to vascular bulging lesions without vessels arising from the apex, observed using volume-rendered TOF-MRA in the circle-of-Willis compared with time-of-flight magnetic resonance angiography (TOF-MRA). Study type Retrospective. Population A total of 299 patients who underwent 3D-PD MRI, digital subtraction angiography (DSA), and TOF-MRA between January 2012 and December 2016 were retrospectively enrolled in this study. Field strength/sequence 3 Tesla, 3D-PD MRI. Assessment Three neuroradiologists independently evaluated TOF-MRA and 3D-PD MRI combined with TOF-MRA for the determination of intracranial aneurysms in patients with index lesions within the circle of Willis. Final diagnoses were made by another neuroradiologist and neurointerventionist in consensus using DSA as the reference standard. The diagnostic performance and proportions of undetermined lesions on TOF-MRA and 3D-PD MRI with TOF-MRA were assessed based on the final diagnoses. Statistical tests The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of unruptured intracranial aneurysms were calculated for each imaging modality. Results Of 452 lesions identified on volume-rendered TOF-MRA images, 173 (38%) aneurysms and 276 (61%) infundibula were finally diagnosed on DSA. 3D-PD MRI with TOF-MRA showed superior diagnostic performance (p = .001; accuracy, 85.5% versus 95.4%), superior area under the receiver operating characteristic curve over TOF-MRA (p = .001; 0.837 versus 0.947), and a lower proportion of undetermined lesions than TOF-MRA (p = .001; 25.1% versus 2.3%). Data conclusion For unruptured intracranial aneurysms in the circle of Willis, 3D-PD MRI can complement TOF-MRA to improve diagnostic performance and lower the proportion of undetermined lesions.
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Gildea, Carolynn, Georgios Lyratzopoulos, Sean McPhail, Ruth Swann, and Gary Abel. "Investigating the impact of case-mix on general practice cancer diagnostic outcome indicators." British Journal of General Practice 69, suppl 1 (June 2019): bjgp19X702881. http://dx.doi.org/10.3399/bjgp19x702881.
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BackgroundThe Cancer Services profiles report indicators of cancer diagnostic activity for all English general practices. A recent study reported that several indicators were dominated by chance, with some practice-level variation explained by the practice’s age-sex profile.AimTo assess the variation explained by patient-level case-mix and whether the practice age-sex profile adequately adjusts for this.MethodFive indicators from Cancer Waiting Times (2016/17, 6050 practices) or Routes to Diagnosis (2015, 6355 practices) data were considered: Two Week Wait (TWW) conversion and detection rates, and emergency-, referred- and other-diagnosis proportions. Mixed-effect logistic regression adjusted for patient-level case-mix, using national cancer registration data on age, sex, deprivation, referral/cancer-type and, where possible, ethnicity and stage at diagnosis, with and without practice-level age-sex profile.ResultsChance explained 60–85% of practice-level variation, with the combination of chance and patient-level case-mix explaining 75% (TWW conversion rate) to 89% (emergency diagnosis proportion). For TWW conversion rate, there was considerable overlap in the variance explained by practice- and patient-level factors. For the other indicators, practice- or patient-level factors were largely independent.ConclusionChance is not synonymous with case-mix and is the dominant source of variation in single-year practice indicators. Therefore, we recommend the continued aggregation of data over multiple years. For most studied indicators, adjustment for the age-sex profile of the whole practice population is not a substitute for case-mix of individual cancer patients and so should not be used. Patient-level case-mix adjustment leads to a modest reordering of practices and so may not be a priority.
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Nikoloulopoulos, Aristidis K. "A multinomial quadrivariate D-vine copula mixed model for meta-analysis of diagnostic studies in the presence of non-evaluable subjects." Statistical Methods in Medical Research 29, no. 10 (April 23, 2020): 2988–3005. http://dx.doi.org/10.1177/0962280220913898.
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Diagnostic test accuracy studies observe the result of a gold standard procedure that defines the presence or absence of a disease and the result of a diagnostic test. They typically report the number of true positives, false positives, true negatives and false negatives. However, diagnostic test outcomes can also be either non-evaluable positives or non-evaluable negatives. We propose a novel model for the meta-analysis of diagnostic studies in the presence of non-evaluable outcomes, which assumes independent multinomial distributions for the true and non-evaluable positives, and, the true and non-evaluable negatives, conditional on the latent sensitivity, specificity, probability of non-evaluable positives and probability of non-evaluable negatives in each study. For the random effects distribution of the latent proportions, we employ a drawable vine copula that can successively model the dependence in the joint tails. Our methodology is demonstrated with an extensive simulation study and applied to data from diagnostic accuracy studies of coronary computed tomography angiography for the detection of coronary artery disease. The comparison of our method with the existing approaches yields findings in the real data application that change the current conclusions.
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Khelifi, Nada, Claudia Blais, Sonia Jean, Denis Hamel, Marie-Annick Clavel, Philippe Pibarot, and Fabrice Mac-Way. "Temporal trends of aortic stenosis and comorbid chronic kidney disease in the province of Quebec, Canada." Open Heart 9, no. 1 (June 2022): e001923. http://dx.doi.org/10.1136/openhrt-2021-001923.
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ObjectiveTo investigate temporal trends of chronic kidney disease (CKD) among patients with incident aortic stenosis (AS) and to compare these trends with that of a matched control population.MethodsUsing the Quebec Integrated Chronic Disease Surveillance System, we performed a population-based nested case-control study including 108 780 patients newly hospitalised with AS and 543 900 age-matched, sex-matched and fiscal year-matched patients without AS from 2000 to 2016 in Quebec (Canada). Three subgroups were considered. Dialysis subgroup had at least two outpatient billing codes of dialysis. The predialysis subgroup had at least one hospital or two billing diagnostic codes of CKD. The remaining individuals were included in the non-CKD subgroup. We estimated overall and sex-specific standardised annual proportions of CKD subgroups through direct standardisation using the 2016–2017 age structure of the incident AS cohort. The trends overtime were estimated through fitting robust Poisson regression models. Age-specific distribution of AS and control population were assessed for each subgroup.ResultsFrom 2000 to 2016, age-standardised proportions of patients with AS with dialysis and predialysis increased by 41% (99% CI 12.0% to 78.1%) and by 45% (99% CI 39.1% to 51.6%), respectively. Inversely, age-standardised proportions of dialysis and pre-dialysis among non-AS patients decreased by 63% (99% CI 55.8% to 68.7%) and by 32% (99% CI 29.9% to 34.6%), respectively, during the same study period. In patients with and without AS, age-standardised annual proportions of males in predialysis were significantly higher than females in most of the study period. Patients with AS on dialysis and predialysis were younger than their respective controls (dialysis: 29.6% vs 45.1% had ≥80 years, predialysis: 60.8% vs 72.7% had ≥80 years).ConclusionsOver time, the proportion of patients with CKD increased significantly and remained consistently higher in incident AS individuals compared with controls. Our results highlight the need to investigate whether interventions targeting CKD risk factors may influence AS incidence in the future.
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Måwe, Leif, Lena Måwe Thorén, and Gunnvald Kvarstein. "Responses after spinal interventions in a clinical pain practice – a pragmatic observational study." Scandinavian Journal of Pain 20, no. 3 (July 28, 2020): 469–82. http://dx.doi.org/10.1515/sjpain-2019-0126.
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AbstractIntroductionThere is limited evidence for effect of interventional treatment, and pragmatic studies are needed to assess these interventions within a clinical setting. The aim of this study was to describe patients referred to an interventional pain clinic and investigate responses after spinal intervention in general and for radiofrequency ablation (RFA) and transforaminal epidural corticosteroid administration (TECA), specifically.MethodsThis is a prospective, non-controlled study of patients with chronic spinal pain. The procedures were performed in accordance with the Spine Intervention Society recommendations. Outcome data after a median of 4.5 months are presented, and for those treated with RFA also after 6 and 12 months.ResultsAmong 815 patients, 190 patients underwent diagnostic blocks only and 625 interventional treatment, of these 94 RFA and 246 TECA. Of the whole sample 70% reported pain reduction, for 49% ≥ 50%, while 9% were pain free (p < 0.001). Highest pain intensity decreased from 7.1 to 5.4 [95% Confidence Interval of the Difference (95%-CI): 1.4–1.9] (p < 0.001), while Euroqual – visual analogue scale for general health (EQ-VAS) improved from 48 to 58 (95%-CI: 7.6–11.9) (p < 0.001), and Euroqual-5 Dimensions-5 Levels Index for health related quality of life (EQ-5D-5L Index) from 0.489 to 0.628 (95%-CI: 0.123–0.157) (p < 0.001). The proportions, not taking analgesics, increased from 16% to 30%, and proportion taking strong opioids decreased from 14% to 9% (p < 0.001). We found no significant change in proportion receiving physiotherapy/other treatment nor occupational status. No complications were reported. Among patients treated with RFA, 77% reported pain reduction, for 56% ≥ 50%, while 9% were pain free (p < 0.001). Highest pain intensity decreased from 6.9 to 4.6 (95%-CI: 1.6–3.0) (p < 0.001), while EQ-VAS improved from 47 to 57 (95%-CI: 4.8–13.6 (p < 0.001), and EQ-5D-5L Index from 0.489 to 0.643 (95%-CI: 0.117–0.191) (p < 0.001). The proportion not taking analgesics, increased from 7% to 23% and proportion taking strong opioids decreased from 16% to 10%. Among patients who responded at 6- and 12-month follow up, the proportions reporting pain reduction, EQ-VAS, and EQ-5D-5L Index remained significantly improved from baseline, and the change in proportions taking analgesic and opioids achieved statistical significance. We found no significant change in proportion receiving physiotherapy/other treatment nor occupational status. Among patients treated with TECA, 58% reported pain reduction, for 36% ≥ 50%, while 5% were pain free (p < 0.001). Highest pain intensity decreased from 7.2 to 6.2 (95%-CI 0.5–1.4) (p < 0.001), while EQ-VAS improved from 46 to 52 (95%-CI: 2.0–3.6) (p < 0.001), and EQ-5D-5L Index from 0.456 to 0.571 (95%-CI: 0.077–0.138) (p < 0.001). The proportions, not taking analgesics, increased from 17% to 27% and proportion taking strong opioids decreased from 15% to 10%, but the changes did not reach statistical significance. We found no significant changes in the proportion who recieved physiotherapy/other treatment nor occupational status.ConclusionThe study demonstrates substantial short-term responses after spinal intervention and long-lasting improvement for a subsample of the RFA treated patients. We observed larger proportions reporting pain reduction among those treated with cervical RFA.ImplementationQuality assessment should be implemented in interventional pain clinics to improve treatment quality.
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Plante, C., S. Goudreau, L. Jacques, and F. Tessier. "Concordance entre les résultats d'une enquête et les données de la Régie de l’assurance maladie du Québec (RAMQ) pour le diagnostic d’asthme et pour l’utilisation des services médicaux pour asthme chez les enfants." Maladies chroniques et blessures au Canada 34, no. 4 (November 2014): 279–86. http://dx.doi.org/10.24095/hpcdp.34.4.09f.
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Introduction L'objectif est d'évaluer la concordance, quant au diagnostic de l'asthme et à l'utilisation des services médicaux, entre les résultats d'une enquête réalisée à Montréal sur la santé respiratoire des enfants de 6 mois à 12 ans et la base de données de la Régie de l'assurance maladie du Québec (RAMQ). Nous avons voulu également évaluer l'effet du mode d'enquête (Internet ou téléphone). Méthodologie On a mesuré l'existence d'un diagnostic d'asthme pour 7 922 enfants. On a comparé également l'utilisation des services médicaux pour asthme (visites à l'urgence et hospitalisations) dans les douze derniers mois précédant l'enquête pour les 402 enfants considérés comme asthmatiques, à l'aide de deux groupes de diagnostics respiratoires et deux périodes de couplage. La concordance entre les deux sources a été évaluée à l'aide du coefficient kappa de Cohen (κ), de la sensibilité et de la spécificité ainsi qu'en mesurant, pour l'utilisation des services, les proportions d'accord, de sur-déclaration et de sous-déclaration. Résultats La concordance entre les deux sources (enquête et RAMQ) est modérée pour le diagnostic d'asthme (κ = 0,54 et κ = 0,60 selon la définition utilisée). La spécificité est élevée (93 % et 96 %) et la sensibilité variable (50 % et 65 %). Il y a une surdéclaration d'utilisation des services par les répondants, avec des coefficients kappa modérés (0,49 pour les visites aux urgences et 0,48 pour les hospitalisations), mais ces derniers augmentent lorsque l'on inclut davantage de diagnostics dans la définition et que l'on allonge (à 15 mois plutôt que 12) la période de couplage (0,59 pour les visites et 0,64 pour les hospitalisations). La sensibilité et la spécificité sont élevées. La concordance est légèrement plus élevée pour l'enquête par Internet que par téléphone. Conclusion Ces résultats valident l'utilisation des données d'enquête concernant l'asthme pédiatrique et l'utilisation des services principaux en relation avec cette maladie.
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Moore, Fraser G. A., and Colin Chalk. "How Well Does Neurology Residency Mirror Practice?" Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 32, no. 4 (May 2005): 472–76. http://dx.doi.org/10.1017/s0317167100004467.
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ABSTRACT:Objective:To report the residency training experience of two neurologists, focusing on setting and diagnoses encountered.Methods:Data from prospective patient logs kept by the authors during residencies completed a decade apart were compared with each other and the literature.Results:The range of diagnoses was broadly similar between residencies, as were the proportions of common or uncommon disorders, and the proportion of cases without a neurological diagnosis. Although most patients were seen in in-patient settings, the rates at which common neurological conditions and functional disorders were seen was comparable to published experiences of community neurologists.Conclusions:The diagnostic profile of North American neurology residency appears to be relatively stable, regardless of location or date of training. In several respects, the content of current neurology residencies mirrors clinical practice well. Changes to residency training are doubtless needed, but they should be guided by a clear understanding of the experiences of contemporary trainees.
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Tikkakoski, T., M. Päivänsalo, T. Siniluoto, S. Hiltunen, T. Typpö, P. Jartti, and M. Apaja-Sarkkinen. "Percutaneous Ultrasound-Guided Biopsy." Acta Radiologica 34, no. 1 (January 1993): 30–34. http://dx.doi.org/10.1177/028418519303400107.
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The results of 155 US-guided cutting needle biopsies, mainly of abdominal and transthoracic lesions, were reviewed to assess the diagnostic accuracy of the method. A fine needle biopsy (FNB) was additionally performed in 99 of the patients. Sufficient material for histologic and cytologic analysis was obtained in 88% (137/155) and 98% (97/99), and a correct benign or malignant diagnosis was made in 87% and 88%, respectively. Among the 99 combined biopsies the corresponding figures were 100% and 97%, respectively. The proportions of inconclusive and false-negative results among histologic samples were 0% and 4% (2/57), in FNBs 7% (7/99) and 5% (3/56), and in combined examinations 3% (3/99) and 0%. One major complication, Streptococcus faecalis sepsis, occurred. The combined use of FNB and histologic biopsy increases the proportion of correct diagnoses about 10% without increasing the complications.
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Hasman, A., and H. Prins. "Long-term Impact of Physician Encoding on Detail and Number of Recorded Diagnoses." Methods of Information in Medicine 50, no. 02 (2011): 115–23. http://dx.doi.org/10.3414/me09-01-0062.
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Summary Objectives: To improve the recording of diagnostic discharge data, pediatricians encoded diagnostic information as part of discharge letter writing supported by a pediatric list of ICD-9-CM-based codes. We evaluated the effect of this new policy on level of detail and number of recorded diagnoses. Methods: We compared proportions of specific principal diagnoses and numbers of secondary diagnoses of the four years before with the eight years after introduction. Results: Immediately after introduction, half of the diagnoses for which both generic and specific codes existed was coded specific. In later years this proportion remained stable at 0.35 (p < 0.05). Diagnoses that fall under the pediatrician’s own subspecialty had more often a specific code than diagnoses that do not. The mean number of secondary diagnoses per admission increased from 0.7 before introduction to 1.4 in the third year after introduction (p < 0.05) but gradually fell back to 0.7. This increase and decrease was mainly due to diagnoses that did not fall under the pediatrician’s own subspecialty. The extra codes in individual discharge summaries had added informational value. Conclusions: Discharge letter-linked encoding by pediatricians supported by a pediatric list of diseases leads initially to increased detail and number of diagnoses with added informational value. When attention diminishes, especially the level of detail and number of secondary diagnoses that do not fall under one’s own subspecialty decrease. The level of detail of principal diagnoses remains stable because of the advantage for pediatricians of having specific diagnostic codes falling under their own subspecialty.
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Vinny, Pulikottil Wilson, Madakasira Vasantha Padma, P. N. Sylaja, Praveen Kesav, Vivek Lal, Lakshmi Narasimhan, S. N. Dwivedi, et al. "Comparison of Diagnostic Accuracy in Vascular Neurology Between Neurology Residents and a Neurology Differential Diagnosis App: A Multi-Center Cross-Sectional Observational Study." Journal of Stroke Medicine 3, no. 1 (May 20, 2020): 21–27. http://dx.doi.org/10.1177/2516608520901388.
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Background: Diagnostic errors in neurological diagnosis are a source of preventable harm. Software tools like Differential Diagnosis (DDx) apps in neurology that hold the potential to mitigate this harm are conspicuously lacking. Materials and Methods: A multicenter cross-sectional observational study was designed to compare the diagnostic accuracy of a Neurology DDx App (Neurology Dx) with neurology residents by using vascular neurology clinical vignettes. The study was conducted at 7 leading neurology institutes in India. Study participants comprised of 100 neurology residents from the participating institutes. Measurements: Detecting diagnostic accuracy of residents and App measured as a proportion of correctly identified high likely gold standard DDx was prespecified as the main outcome. Proportions of correctly identified first high likely, first 3 high likely, first 5 high likely, and combined moderate plus high likely gold standard differentials by residents and App were secondary outcomes. Results: 1,000 vignettes were attempted by residents. Frequency of gold standard, high likely differentials correctly identified by residents was 27% compared to 72% by App (absolute difference 45%, 95% CI 35.7-52.8). When high and moderate likely differentials were combined, residents scored 17% compared to 57% by App (absolute difference 40%, 95% CI 33.8-50.0). Residents correctly identified first high likely gold standard differential as their first high likely differential in 34% compared to 18% by App (absolute difference 16%, 95% CI 1.2-25.4). Conclusion: App with predefined knowledge base can complement clinical reasoning of neurology residents. Portability and functionality of such Apps may further strengthen this symbiosis between humans and algorithms (CTRI/2017/06/008838).
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Gatalica, Zoran, Liqiang Wang, Emmanuel T. Lucio, and Markku Miettinen. "Glomus Coccygeum in Surgical Pathology Specimens." Archives of Pathology & Laboratory Medicine 123, no. 10 (October 1, 1999): 905–8. http://dx.doi.org/10.5858/1999-123-0905-gcisps.
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Abstract Background.—Rarely encountered nonpathologic structures may pose diagnostic problems and cause unnecessary special investigations. More importantly, however, they may be falsely accused as culprits in unrelated pathologic processes. Glomus coccygeum is one such structure. Glomus bodies (including coccygeal glomus) consist of modified smooth muscle cells arranged in layers around small vascular channels. When found in distal extremities, they generally do not represent a diagnostic problem; however, large glomus bodies present in a pericoccygeal location (glomus coccygeum) may cause significant problems for a surgical pathologist unfamiliar with this structure. Design.—We reviewed 37 coccygeal bones removed during rectal resection for carcinoma (rectal and uterine) and for various other reasons, among which was a single case of coccygodynia. Immunohistochemical and ultrastructural examinations were performed in selected cases. Results.—Sharply circumscribed glomus bodies composed of various proportions of glomus cells without atypia or pleomorphism and without expansile growth or infiltration of surrounding soft tissue or bone were identified in 50% of cases. Size varied significantly (maximum 4 mm), but paradoxically the smallest glomus body (less than 1 mm) was found in the case of coccygodynia. Glomus coccygeum posed a significant diagnostic challenge to the pathologists involved in these cases, as the retrospective review found that it was diagnosed correctly in only 3 cases. Conclusions.—Glomus coccygeum is a nonpathologic structure that exhibits significant variation in size and proportion of the constitutive elements. Immunohistochemical demonstration of smooth muscle actin and neuron-specific enolase in glomus cells may be beneficial for accurate identification of this organelle.
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Kaliuzhna, M. O. "Review of Metanotal Sculpture of Aphidiine Wasps (Hymenoptera, Braconidae, Aphidiinae)." Vestnik Zoologii 50, no. 6 (December 1, 2016): 511–16. http://dx.doi.org/10.1515/vzoo-2016-0058.
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Abstract Morphological data on metanotal sculpture of aphidiine wasps (Hymenoptera, Braconidae, Aphidiinae), are reviewed based on the specimens collected in Ukraine. Specimens of 20 species of 13 genera were studied using light and scanning electron microscopy. Differences in menatonal morphology appear diagnostic for some genera or generic groups, such as tribes and subtribes. Seven general types of metanotal sculpture were distinguished. The proposed diagnostic characters are: the relative proportions of the metanotum and its parts (metascutellum, metascutellar arms), the shape and setation of the metascutellum, the number and form of the carinae arising from the base of metascutellum toward the mesoscutellum. To facilitate describing the structure of the metanotum in Aphidiinae, following measurements were established: the length and width of the metanotum and the metascutellum, the length of the metascutellar arms. The discovered characters could be used as additional diagnostic tools for aphidiine identification, and perhaps also in studies on their evolution and phylogeny.
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REICZIGEL, J., J. SINGER, and ZS LANG. "Exact inference for the risk ratio with an imperfect diagnostic test." Epidemiology and Infection 145, no. 1 (September 9, 2016): 187–93. http://dx.doi.org/10.1017/s0950268816002028.
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SUMMARYThe risk ratio quantifies the risk of disease in a study population relative to a reference population. Standard methods of estimation and testing assume a perfect diagnostic test having sensitivity and specificity of 100%. However, this assumption typically does not hold, and this may invalidate naive estimation and testing for the risk ratio. We propose procedures that control for sensitivity and specificity of the diagnostic test, given the risks are measured by proportions, as it is in cross-sectional studies or studies with fixed follow-up times. These procedures provide an exact unconditional test and confidence interval for the true risk ratio. The methods also cover the case when sensitivity and specificity differ in the two groups (differential misclassification). The resulting test and confidence interval may be useful in epidemiological studies as well as in clinical and vaccine trials. We illustrate the method with real-life examples which demonstrate that ignoring sensitivity and specificity of the diagnostic test may lead to considerable bias in the estimated risk ratio.
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Gupta, Ashwin, Lindsay Petty, Tejal Gandhi, Scott Flanders, Lama Hsaiky, Tanima Basu, Qisu Zhang, et al. "Overdiagnosis of urinary tract infection linked to overdiagnosis of pneumonia: a multihospital cohort study." BMJ Quality & Safety 31, no. 5 (January 5, 2022): 383–86. http://dx.doi.org/10.1136/bmjqs-2021-013565.
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Urinary tract infection (UTI) and community-acquired pneumonia (CAP) are the most common infections treated in hospitals. UTI and CAP are also commonly overdiagnosed, resulting in unnecessary antibiotic use and diagnostic delays. While much is known individually about overdiagnosis of UTI and CAP, it is not known whether hospitals with higher overdiagnosis of one also have higher overdiagnosis of the other. Correlation of overdiagnosis of these two conditions may indicate underlying hospital-level contributors, which in turn may represent targets for intervention. To evaluate the association of overdiagnosis of UTI and CAP, we first determined the proportion of hospitalised patients treated for CAP or UTI at 46 hospitals in Michigan who were overdiagnosed according to national guideline definitions. Then, we used Pearson’s correlation coefficient to compare hospital proportions of overdiagnosis of CAP and UTI. Finally, we assessed for ‘diagnostic momentum’ (ie, accepting a previous diagnosis without sufficient scepticism) by determining how often overdiagnosed patients remained on antibiotics on day 3 of hospitalisation. We included 14 085 patients treated for CAP (11.4% were overdiagnosed) and 10 398 patients treated for UTI (27.8% were overdiagnosed) across 46 hospitals. Within hospitals, the proportion of patients overdiagnosed with UTI was moderately correlated with the proportion of patients overdiagnosed with CAP (r=0.53, p<0.001). Over 80% (81.8% (n=952/1164) of UTI; 89.9% (n=796/885) of CAP) of overdiagnosed patients started on antibiotics by an emergency medicine clinician remained on antibiotics on day 3 of hospitalisation. In conclusion, we found overdiagnosis of UTI and CAP to be correlated at the hospital level. Reducing overdiagnosis of these two common infections may benefit from systematic interventions.