scholarly journals Factors associated with positive predictive value of preliminary screening in a two-step screening strategy for colorectal neoplasms in China

2022 ◽  
Vol 13 (1) ◽  
Author(s):  
Ji-Bin Li ◽  
Zhi-Yu Qiu ◽  
Yu-Xiang Deng ◽  
Yin Li ◽  
Zhuo-Chen Lin ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Positive Predictive Value ◽  
Colorectal Neoplasms ◽  
Predictive Value ◽  
Screening Strategy ◽  
Advanced Adenoma ◽  
Preliminary Screening ◽  
Factors Associated ◽  
Advanced Neoplasm

Abstract Background The positive predictive value (PPV) of high risk factor questionnaire (HRFQ) plus fecal immunochemical test (FIT) as preliminary screening strategy for colorectal-related neoplasia is relatively low. We aim to explore independent factors associated with PPVs of HRFQ combined FIT for selecting high risk individuals for colonoscopy. Methods A total of 6971 residents were enrolled in a community-based screening program. Participants who had positive results of HRFQ and/or FIT and subsequently received colonoscopy were involved. The associations of socio-demographic factors, lifestyle behaviors, and high risk factors of colorectal cancer with PPVs of HRFQ, FIT, and their combination were evaluated by multivariable logistic regression models. Results Among 572 involved cases, 249 (43.5%) colorectal neoplasms were detected by colonoscopy, including 71 advanced adenoma (12.4%) and 9 colorectal cancer (CRC) (1.6%). The PPVs of preliminary screening were 43.5% for total colorectal neoplasms, 14.0% for advanced neoplasm, and 1.6% for CRC. Adding positive HRFQ to FIT could improve the PPV from 3.5 to 8.0% for detecting CRC. Preliminarily screened positive individuals who were males [adjusted odds ratio (AOR): 1.95, 95% CI 1.31, 2.90; p  < 0.001], elders (> 60 years) (AOR: 1.70, 95% CI 1.17, 2.46; p  = 0.005), or ex-/current smokers (AOR: 3.04, 95% CI 1.31, 7.09; p  = 0.10) had higher odds of PPVs of detecting colorectal neoplasms. Conclusions Combining HRFQ and FIT could largely improve PPVs for screening advanced neoplasm and CRC. Gender and age-specific FIT cut-off values as well as initiating ages for CRC screening might be recommended to improve the accuracy and effectiveness of current screening algorithm.

scholarly journals Effects of antithrombotic drugs on the results of fecal immunochemical test in colorectal neoplasms screening

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Takashi Ibuka ◽  
Seiji Adachi ◽  
Yohei Horibe ◽  
Tomohiko Ohno ◽  
Masatoshi Mabuchi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Positive Predictive Value ◽  
Colorectal Neoplasms ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Fecal Immunochemical Test ◽  
Advanced Adenoma ◽  
Antithrombotic Drugs ◽  
Significant Difference ◽  
Immunochemical Test

AbstractFecal immunochemical test (FIT) is widely used as a colorectal cancer screening tool. Antithrombotic drugs may affect the screening performance of FIT for colorectal tumors. The aim of this study was to clarify the effect of antithrombotic agents on FIT accuracy in screening for colorectal neoplasms. This retrospective study enrolled a total of 758 patients who underwent both FIT and total colonoscopy. The effect of antithrombotic drugs on FIT accuracy in detecting colorectal neoplasms (CN), including colorectal cancer (CRC), advanced adenoma (AA), and non-advanced adenoma (NAA), was examined. Of the 758 patients, 144 (19%) received antithrombotic drugs (administration group). In administration group, 61/144 (42%) cases had CN [CRC:14, AA:15, NAA:32] and 217/614 (35%) cases had CN (CRC:43, AA:56, NAA:118) in non-administration group. The prevalence of CN was not significantly different between the two groups (p = 0.1157). There was no significant difference in sensitivity or specificity of the detection of all types of CN with or without taking antithrombotic drugs. Neither the positive predictive value nor negative predictive value of FIT was affected by antithrombotic drug administration. Taking antithrombotic drugs may not have a large impact on sensitivity, specificity, positive predictive value, or negative predictive value of FIT in screening for CN.

Identifying children at high risk for infection-related decompensation using a predictive emergency department-based electronic assessment tool

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Robert J. Sepanski ◽  
Arno L. Zaritsky ◽  
Sandip A. Godambe
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Positive Predictive Value ◽  
Firing Rate ◽  
Predictive Value ◽  
Assessment Tool ◽  
Predictive Tool ◽  
High Severity ◽  
Electronic Assessment ◽  
Ed Visits

AbstractObjectivesElectronic alert systems to identify potential sepsis in children presenting to the emergency department (ED) often either alert too frequently or fail to detect earlier stages of decompensation where timely treatment might prevent serious outcomes.MethodsWe created a predictive tool that continuously monitors our hospital’s electronic health record during ED visits. The tool incorporates new standards for normal/abnormal vital signs based on data from ∼1.2 million children at 169 hospitals. Eighty-two gold standard (GS) sepsis cases arising within 48 h were identified through retrospective chart review of cases sampled from 35,586 ED visits during 2012 and 2014–2015. An additional 1,027 cases with high severity of illness (SOI) based on 3 M’s All Patient Refined – Diagnosis-Related Groups (APR-DRG) were identified from these and 26,026 additional visits during 2017. An iterative process assigned weights to main factors and interactions significantly associated with GS cases, creating an overall “score” that maximized the sensitivity for GS cases and positive predictive value for high SOI outcomes.ResultsTool implementation began August 2017; subsequent improvements resulted in 77% sensitivity for identifying GS sepsis within 48 h, 22.5% positive predictive value for major/extreme SOI outcomes, and 2% overall firing rate of ED patients. The incidence of high-severity outcomes increased rapidly with tool score. Admitted alert positive patients were hospitalized nearly twice as long as alert negative patients.ConclusionsOur ED-based electronic tool combines high sensitivity in predicting GS sepsis, high predictive value for physiologic decompensation, and a low firing rate. The tool can help optimize critical treatments for these high-risk children.

scholarly journals Reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications

2014 ◽  
Vol 47 (1) ◽  
pp. 28-32 ◽  
Author(s):  
Vilson Lacerda Brasileiro Junior ◽  
Aníbal Henrique Barbosa Luna ◽  
Marcelo Augusto Oliveira de Sales ◽  
Tânia Lemos Coelho Rodrigues ◽  
Priscilla Lopes da Fonseca Abrantes Sarmento ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Carotid Arteries ◽  
Panoramic Radiography ◽  
Digital Panoramic Radiography ◽  
Significant Difference ◽  
Mcnemar’S Test ◽  
Sensitivity Specificity

Objective The present study evaluated the reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications. Materials and Methods Thirty-five patients under high-risk for development of carotid artery calcifications who had digital panoramic radiography were referred to undergo ultrasonography. Thus, 70 arteries were assessed by both methods. The main parameters utilized to evaluate the panoramic radiography reliability in the diagnosis of carotid artery calcifications were accuracy, sensitivity, specificity and positive predictive value of this method as compared with ultrasonography. Additionally, the McNemar's test was utilized to verify whether there was a statistically significant difference between digital panoramic radiography and ultrasonography. Results Ultrasonography demonstrated carotid artery calcifications in 17 (48.57%) patients. Such individuals presented with a total of 29 (41.43%) carotid arteries affected by calcification. Radiography was accurate in 71.43% (n = 50) of cases evaluated. The degree of sensitivity of this method was 37.93%, specificity of 95.12% and positive predictive value of 84.61%. A statistically significant difference (p < 0.001) was observed between the methods evaluated in their capacity to diagnose carotid artery calcifications. Conclusion Digital panoramic radiography should not be indicated as a method of choice in the investigation of carotid artery calcifications.

scholarly journals Language Delay Is Not Predictable from Available Risk Factors

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Philip Wilson ◽  
Fiona McQuaige ◽  
Lucy Thompson ◽  
Alex McConnachie
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Male Gender ◽  
Language Delay ◽  
Predictive Capacity ◽  
Factors Associated ◽  
Health Visitors

Aims. To investigate factors associated with language delay in a cohort of 30-month-old children and determine if identification of language delay requires active contact with families.Methods. Data were collected at a pilot universal 30-month health contact. Health visitors used a simple two-item language screen. Data were obtained for 315 children; language delay was found in 33. The predictive capacity of 13 variables which could realistically be known before the 30-month contact was analysed.Results. Seven variables were significantly associated with language delay in univariate analysis, but in logistic regression only five of these variables remained significant.Conclusion. The presence of one or more risk factors had a sensitivity of 89% and specificity of 45%, but a positive predictive value of only 15%. The presence of one or more of these risk factors thus can not reliably be used to identify language delayed children, nor is it possible to define an “at risk” population because male gender was the only significant demographic factor and it had an unacceptably low specificity (52.5%). It is not possible to predict which children will have language delay at 30 months. Identification of this important ESSENCE disorder requires direct clinical contact with all families.

scholarly journals Early Prediction of Multiple Organ Dysfunction in the Pediatric Intensive Care Unit

2021 ◽  
Vol 9 ◽  
Author(s):  
Sanjukta N. Bose ◽  
Joseph L. Greenstein ◽  
James C. Fackler ◽  
Sridevi V. Sarma ◽  
Raimond L. Winslow ◽  
...  
Keyword(s):  
High Risk ◽  
Random Forest ◽  
Positive Predictive Value ◽  
Organ Dysfunction ◽  
Predictive Value ◽  
Prediction Models ◽  
Pediatric Intensive Care ◽  
Multiple Organ ◽  
High Risk Group ◽  
Early Prediction

Objective: The objective of the study is to build models for early prediction of risk for developing multiple organ dysfunction (MOD) in pediatric intensive care unit (PICU) patients.Design: The design of the study is a retrospective observational cohort study.Setting: The setting of the study is at a single academic PICU at the Johns Hopkins Hospital, Baltimore, MD.Patients: The patients included in the study were &lt;18 years of age admitted to the PICU between July 2014 and October 2015.Measurements and main results: Organ dysfunction labels were generated every minute from preceding 24-h time windows using the International Pediatric Sepsis Consensus Conference (IPSCC) and Proulx et al. MOD criteria. Early MOD prediction models were built using four machine learning methods: random forest, XGBoost, GLMBoost, and Lasso-GLM. An optimal threshold learned from training data was used to detect high-risk alert events (HRAs). The early prediction models from all methods achieved an area under the receiver operating characteristics curve ≥0.91 for both IPSCC and Proulx criteria. The best performance in terms of maximum F1-score was achieved with random forest (sensitivity: 0.72, positive predictive value: 0.70, F1-score: 0.71) and XGBoost (sensitivity: 0.8, positive predictive value: 0.81, F1-score: 0.81) for IPSCC and Proulx criteria, respectively. The median early warning time was 22.7 h for random forest and 37 h for XGBoost models for IPSCC and Proulx criteria, respectively. Applying spectral clustering on risk-score trajectories over 24 h following early warning provided a high-risk group with ≥0.93 positive predictive value.Conclusions: Early predictions from risk-based patient monitoring could provide more than 22 h of lead time for MOD onset, with ≥0.93 positive predictive value for a high-risk group identified pre-MOD.

scholarly journals Non-mass lesions on screening breast ultrasound

2016 ◽  
Vol 18 (4) ◽  
pp. 446 ◽  
Author(s):  
Jihyun Lee ◽  
Jin Hwa Lee ◽  
Seonmi Baik ◽  
Eun Cho ◽  
Dong Won Kim ◽  
...  
Keyword(s):  
High Risk ◽  
Positive Predictive Value ◽  
Prospective Studies ◽  
Predictive Value ◽  
Breast Ultrasound ◽  
Management Guidelines ◽  
Asymptomatic Patients ◽  
Screening Population ◽  
Mass Lesions

Aim: The purpose of this study was to determine the significance of a non-mass lesion (NML) which is recognized during screening breast ultrasound (US). Materials and methods: We included patients with a NML on screening breast US and no suspicious finding on mammography between March 2008 and June 2012. The final diagnoses were based on pathology results and a clinical or sonographic follow-up for more than 12 months. We calculated the incidence, likelihood of malignancy, and positive predictive value (PPV) of biopsy with a review of imaging and histopathological findings. Results: A total of 17868 screening breast US were performed in 8856 asymptomatic patients. Ninety-five NMLs were detected in 88 patients (1.0%). Among the 93 lesions that were followed or confirmed histopathologically, 2 (2.2%) were malignant, 89 (95.6%) were benign, and 2 (2.2%) were high risk lesions. The likelihood of malignancy in a NML on screening breast US was 2.2% and the PPV of biopsy was 6.3% (2 of 32). Conclusion: The likelihood of malignancy for a NML on screening breast US was greater than 2%. It could be classified as a BI-RADS category 4a lesion and tissue diagnosis is warranted. This provides the potential management guidelines for a NML in screening patients and further prospective studies in a large, multicenter screening population are required.

P6540Opportunistic screening for atrial fibrillation in an ambulatory geriatric population with a hand held single lead ECG device

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L A R Zwart ◽  
M E W Hemels ◽  
J R Ruiter ◽  
T Germans ◽  
S Simsek ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Positive Predictive Value ◽  
Outpatient Clinic ◽  
Predictive Value ◽  
Geriatric Patients ◽  
Poor Quality ◽  
Opportunistic Screening ◽  
Geriatric Population ◽  
Handheld Device

Abstract Introduction Atrial fibrillation (AF) is the most common arrhythmia and its incidence rises with age. Especially geriatric patients are at high risk for the development of AF as well as its complications. These high risk patients might benefit the most of oral anticoagulation. AF is however often asymptomatic in these patients and might stay undiagnosed. Purpose To assess the outcomes of opportunistic screening on AF on a geriatric outpatient clinic with a hand held single lead ECG device. Methods All consecutive patients 60 years and older that visited the outpatient clinic between the 1st of June 2017 and the 1st of June 2018 were eligible. Patients who were not able or willing to give informed consent, or had a pacemaker (PM) or internal cardioverter defibrillator (ICD) were excluded. Patients were screened 2 or 3 times at every visit with the MyDiagnostick©, a hand held single lead ECG device with inbuilt algorithm that identifies AF [1]. At baseline all patients underwent a comprehensive geriatric assessment (CGA), including a 12 lead ECG, physical, cognitive and functional assessment and medication review. All baseline ECGs were reviewed by 1 cardiologist and all measurements with the single lead device were reviewed by 2 independent cardiologists. Disagreement about the rhythm on the measurements was resolved by discussion between the cardiologists. Results 498 consecutive patients were eligible for inclusion. We excluded 39 patients: 20 patients had a PM or ICD, 17 did not want to participate and of 2 the medical files were incomplete. A total of 459 patients participated in this study. The mean age was 78±7.3 years and ranged from 60 to 100 years, 245 patients (53%) were female. Patients were known with 5±3 morbidities and used 6±4 different drugs. At baseline 88 (19%) patients were known with AF and AF was first diagnosed in 24 (5%) patients, constituting to an overall prevalence of 23% within this ambulatory geriatric population. Of these 24 patients, 4 (1%) showed AF on their baseline ECG and in 20 (4%) patients AF was found using the handheld device. A total of 1345 measurement with the handheld device were performed, 14 measurements (1%) were of too low quality to use, 32 (2%) were of poor quality, 148 (11%) acceptable and 1151 (86%) were of good quality. Sensitivity of the hand held device for detecting AF is 83.9%, specificity 99.2%, negative predictive value 99.6%, and positive predictive value 72.2%. Conclusions Opportunistic screening for AF with a hand held ECG device has a 5 times higher yield than the standard CGA with an 12 lead ECG at the first visit only. Also, AF can be reliably excluded after a negative measurement. Because of the potential benefit of OAC we advocate screening geriatric patients for AF at every doctor's visit. However, considering the positive predictive value, a confirmatory ECG remains necessary to confirm the diagnosis of AF. Acknowledgement/Funding None

scholarly journals Utility of the methylated SEPT9 test for the early detection of colorectal cancer: a systematic review and meta-analysis of diagnostic test accuracy

2020 ◽  
Vol 7 (1) ◽  
pp. e000355 ◽  
Author(s):  
Rohit Hariharan ◽  
Mark Jenkins
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Early Detection ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Diagnostic Test ◽  
Predictive Value ◽  
Meta Analysis ◽  
Test Accuracy ◽  
Sensitivity Specificity

BackgroundCirculating tumour DNA from colorectal cancer (CRC) is a biomarker for early detection of the disease and therefore potentially useful for screening. One such biomarker is the methylated SEPT9 (mSEPT9) gene, which occurs during CRC tumourigenesis. This systematic review and meta-analysis aims to establish the sensitivity, specificity and accuracy of mSEPT9 tests for the early diagnosis of CRC.MethodsA systematic search of the relevant literature was conducted using Medline and Embase databases. Data were extracted from the eligible studies and analysed to estimate pooled sensitivity, specificity and diagnostic test accuracy.ResultsBased on 19 studies, the pooled estimates (and 95% CIs) for mSEPT9 to detect CRC were: sensitivity 69% (62–75); specificity 92% (89–95); positive likelihood ratio 9.1 (6.1–13.8); negative likelihood ratio 0.34 (0.27–0.42); diagnostic OR 27 (15–48) and area under the curve 0.89 (0.86–0.91). The test has a positive predictive value of 2.6% and negative predictive value of 99.9% in an average risk population (0.3% CRC prevalence), and 9.5% (positive predictive value) and 99.6% (negative predictive value) in a high-risk population (1.2% CRC prevalence).ConclusionThe mSEPT9 test has high specificity and moderate sensitivity for CRC and is therefore a potential alternative screening method for those declining faecal immunochemical test for occult blood (FIT) or other screening modalities. However, it is limited by its poor diagnostic performance for precancerous lesions (advanced adenomas and polyps) and its relatively high costs, and little is known about its acceptability to those declining to use the FIT.

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