Proposing the short Neurological Evaluation Scale

2016 ◽  
Vol 29 (4) ◽  
pp. 236-243 ◽  
Author(s):  
Akin Ojagbemi ◽  
Robin Emsley ◽  
Oye Gureje
Keyword(s):  
Neurological Examination ◽  
Rapid Screening ◽  
First Episode ◽  
Clinical Settings ◽  
Likelihood Ratios ◽  
Confirmatory Factor Analyses ◽  
Neurological Evaluation ◽  
Time Required ◽  
Test Probability ◽  
Existing Data

ObjectivesThe time required in completing the 26 items of neurological examinations in the standard Neurological Evaluation Scale (NES) may limit its utility in pragmatic clinical situations. We propose the Short Neurological Evaluation Scale (S-NES) for use in busy clinical settings, and in research.MethodsUsing confirmatory factor analyses, we identified 12 items of neurological examination showing significant overlap with previously reported theoretical and empirical categories of neurological soft signs (NSS) in schizophrenia. This provided justification for the development of a shorter version of the NES based on the empirically identified NSS. In the present study, we relied on existing data to present an initial validation of the S-NES against the referent standard 26-item NES. We determined sensitivity, specificity, and likelihood ratios. Posterior-test probability was estimated using a Bayesian nomogram plot.ResultsUsing data derived from 84 unmedicated or minimally treated patients with first-episode schizophrenia, 12 empirically determined items of neurological examinations showed high agreement with the 26 items in the standard NES battery (sensitivity=96.3%, specificity=100%, and posterior-test probability=100%).ConclusionsWithin limitations of validity estimates derived from existing data, the present results suggest that the design of the S-NES based on empirically identified 12 items of neurological examination is a logical step. If successful, the S-NES will be useful for rapid screening of NSS in busy clinical settings, and also in research.

Featureless Data Clustering

2010 ◽  
pp. 141-164 ◽  
Author(s):  
Wilson Wong
Keyword(s):  
Data Clustering ◽  
Dominant Role ◽  
Clustering Algorithms ◽  
Adaptive Clustering ◽  
Feature Based ◽  
Clustering Approach ◽  
Semantic Computation ◽  
The Many ◽  
Time Required ◽  
Existing Data

Feature-based semantic measurements have played a dominant role in conventional data clustering algorithms for many existing applications. However, the applicability of existing data clustering approaches to a wider range of applications is limited due to issues such as complexity involved in semantic computation, long pre-processing time required for feature preparation, and poor extensibility of semantic measurement due to non-incremental feature source. This chapter first summarises the many commonly used clustering algorithms and feature-based semantic measurements, and then highlights the shortcomings to make way for the proposal of an adaptive clustering approach based on featureless semantic measurements. The chapter concludes with experiments demonstrating the performance and wide applicability of the proposed clustering approach.

The Neurologic Examination

2014 ◽  
pp. 935-940
Author(s):  
Galen V. Henderson
Keyword(s):  
Neurological Examination ◽  
Neurological Disease ◽  
Neurologic Examination ◽  
Patient History ◽  
Neurological Evaluation ◽  
Number Of Individuals

The neurological examination is not challenging or complex. It does have many components and includes a number of skills that can be mastered only through repetition of the same techniques on a large number of individuals with and without neurological disease. Please remember that the purpose of the examination is to simply localize the lesion. Based on patient history alone, 80% of lesion locations should be known, and then a very specific neurological examination is performed to confirm the location. The examination is the less time consuming of the two parts of the patient's neurological evaluation.

scholarly journals Predictors and their prognostic value for no ROSC and mortality after a non-cardiac surgery intraoperative cardiac arrest: a retrospective cohort study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Matheus F. Vane ◽  
Maria J. C. Carmona ◽  
Sergio M. Pereira ◽  
Karl B. Kern ◽  
Sérgio Timerman ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Prognostic Value ◽  
Laboratory Data ◽  
Spontaneous Circulation ◽  
Likelihood Ratios ◽  
Receiver Operating Characteristic Curves ◽  
Post Test ◽  
Verbal Component ◽  
Sensitivity Specificity ◽  
Test Probability

Abstract Data on predictors of intraoperative cardiac arrest (ICA) outcomes are scarce in the literature. This study analysed predictors of poor outcome and their prognostic value after an ICA. Clinical and laboratory data before and 24 hours (h) after ICA were analysed as predictors for no return of spontaneous circulation (ROSC) and 24 h and 1-year mortality. Receiver operating characteristic curves for each predictor and sensitivity, specificity, positive and negative likelihood ratios, and post-test probability were calculated. A total of 167,574 anaesthetic procedures were performed, including 158 cases of ICAs. Based on the predictors for no ROSC, a threshold of 13 minutes of ICA yielded the highest area under curve (AUC) (0.867[0.80–0.93]), with a sensitivity and specificity of 78.4% [69.6–86.3%] and 89.3% [80.4–96.4%], respectively. For the 1-year mortality, the GCS without the verbal component 24 h after an ICA had the highest AUC (0.616 [0.792–0.956]), with a sensitivity of 79.3% [65.5–93.1%] and specificity of 86.1 [74.4–95.4]. ICA duration and GCS 24 h after the event had the best prognostic value for no ROSC and 1-year mortality. For 24 h mortality, no predictors had prognostic value.

Understanding the tests that we order: screening for anti-NMDA receptor encephalitis in first episode psychosis

2020 ◽  
Vol 28 (2) ◽  
pp. 199-201
Author(s):  
Joel Singer ◽  
Perminder Sachdev ◽  
Adith Mohan
Keyword(s):  
Nmda Receptor ◽  
Clinical Presentation ◽  
First Episode Psychosis ◽  
Clinical Suspicion ◽  
First Episode ◽  
Nmda Receptor Encephalitis ◽  
Episode Psychosis ◽  
Current Guidelines ◽  
Positive Results ◽  
Test Probability

Objective: The current guidelines recommend screening all patients with first episode psychosis (FEP) for anti-NMDA receptor encephalitis. This paper explores the pitfalls of this strategy. Conclusion: Screening for anti-NMDA receptor encephalitis in patients with FEP when the pre-test probability based on the clinical presentation is low creates a risk of false positive results. Testing based on clinical suspicion would be preferable.

scholarly journals A Protocol to Quantify the Reactivity of Carbonate Lime for Horticultural Substrates

HortScience ◽  
2005 ◽  
Vol 40 (4) ◽  
pp. 1124E-1125
Author(s):  
Jinsheng Huang ◽  
Paul R. Fisher ◽  
William R. Argo
Keyword(s):  
Particle Size ◽  
Reaction Rates ◽  
Rapid Screening ◽  
Reactivity Index ◽  
Analytical Test ◽  
Horticultural Practice ◽  
Ph Level ◽  
Time Required ◽  
Lime Reactivity ◽  
Over Time

Lime sources vary in their reactivity depending on particle size, surface area and crystalline structure, and chemical composition. Current horticultural practice for testing lime reactivity and the appropriate lime rate is through batch trials where lime is incorporated into growing media. Our objective was to test a laboratory approach that would provide a rapid analytical test on reactivity of lime sources, and could eventually be applied to measuring unreacted (residual) lime in container media. Four moles HCl was added to a lime sample, and the volume of CO2 released over time was measured in a burette. Three lime types were tested, including reagent grade CaCO3, and two pulverized dolomitic limestones used in horticultural media. 100% of CaCO3 reacted in less than a minute after acid addition, whereas only 79.8% and 49.5% of the two commercial lime samples had reacted after 10 minutes. The time required for 50% of the two commercial lime samples to react was 5 and 10 minutes, respectively, whereas it took 20 and 60 minutes, respectively, for 95% neutralization. Reaction rates in the laboratory test correlated with the time required to achieve a stable pH level when limes were incorporated into a peat substrate. The reagent-grade CaCO3 raised pH more rapidly (within 7 days) and to a higher level (maximum pH 7.5 at 9 g of lime per liter of peat) compared with the dolomitic lime sources. It may be possible to establish a lime reactivity index, for example, based on CO2 release after 10 minutes, and thereby provide a rapid screening of limes. Further gasometric analysis of lime types used in horticultural substrates is therefore needed.

scholarly journals A “Clinician’s Probability Calculator” to convert pre-test to post-test probability of COVID-19 , based on method validation from each laboratory

2020 ◽  
Author(s):  
Zoe Brooks ◽  
Saswati Das ◽  
Tom Pliura
Keyword(s):  
Health Staff ◽  
Test Results ◽  
Likelihood Ratios ◽  
Percent Agreement ◽  
Public Health Staff ◽  
Post Test ◽  
Online Calculator ◽  
Test Result ◽  
Post Test Probability ◽  
Test Probability

During coronavirus pandemic testing and identifying the virus has been a unique and constant challenge for the scientific community. In this paper, we discuss a practical solution to help guide clinicians and public health staff with the interpretation of the probability that a positive, or negative, COVID-19 test result indicates an infected person, based on their clinical estimate of pre-test probability of infection. The LinkedIn survey confirmed that the pre-test probability of COVID-19 increases with patient age, known contact, and severity of symptoms, as well as prevalence of disease in the local population. PPA (Positive Percent Agreement, PPA) and NPA (Negative Percent Agreement, specificity), differ between individual methods. Results vary between laboratories and the manufacturer for the same method. The confidence intervals of results vary with the number of samples tested, often adding a large range of possibilities to the reported test result. The online calculator met the objective.The authors postulated that the clinical pre-test probability of COVID-19 increases relative to local prevalence of disease plus patient age, known contact, and severity of symptoms. We conducted a small survey on LinkedIn to confirm that hypothesis. We examined results of PPA (Positive Percent Agreement, sensitivity) and NPA (Negative Percent Agreement, specificity) from 73 individual laboratory experiments for molecular tests for SARS-CoV-2as reported to the FIND database,(1) and for selected methods in FDA EUA submissions (2,3). We calculated likelihood ratios to convert pre-test to post-test probability of disease, then further calculated the number of true and false results expected in every ten positive or negative test results, plus an estimate that one in ‘x’ test results is true. We designed an online calculator to create graphics and text to fulfill the objective. A positive or negative test result from one laboratory conveys a higher probability for the presence or absence of COVID-19 than the same result from another laboratory, depending on clinical pre-test probability of disease plus proven method PPA and NPA in each laboratory. Likelihood ratios and confidence intervals provide valuable information but are seldom used in clinical settings. We recommend that testing laboratories verify PPA and NPA, and utilize a tool such as the “Clinician’s Probability Calculator” to verify acceptable test performance and create reports to help guide clinicians and public health staff with estimation of post-test probability of COVID-19 .

Trajectory of neurological examination abnormalities in antipsychotic-naïve first-episode psychosis population: a 1 year follow-up study

2019 ◽  
Vol 50 (12) ◽  
pp. 2057-2065 ◽  
Author(s):  
Paulo Lizano ◽  
Kiranpreet Dhaliwal ◽  
Olivia Lutz ◽  
Suraj Sarvode Mothi ◽  
Jean Miewald ◽  
...  
Keyword(s):  
Neurological Examination ◽  
Motor Coordination ◽  
First Episode Psychosis ◽  
Analysis Of Covariance ◽  
First Episode ◽  
Clinical Tool ◽  
Significant Group ◽  
Clinical Variables ◽  
Episode Psychosis ◽  
Response Groups

AbstractBackgroundNeurological Examination Abnormalities (NES) are quantified by measuring subtle, partially localizable (cerebello-thalamo-prefrontal cortical circuit) and heritable neurological signs comprising sensory integration, motor coordination and complex motor sequencing that are associated with first-episode psychosis (FEP). A few studies have evaluated NES longitudinally and as a predictor for diagnostic and response classification, but these studies have been confounded, underpowered and divergent. We examined (1) baseline and longitudinal NES differences between diagnostic and year 1 response groups; (2) if NES predicts diagnostic and response groups and (3) relationships between clinical variables and NES measures in antipsychotic-naïve FEP.MethodsNES and clinical measures were obtained for FEP-schizophrenia (FEP-SZ, n = 232), FEP non-schizophrenia (FEP-NSZ, n = 117) and healthy controls (HC, n = 204). Response groups with >25% improvement in average year 1 positive and negative symptomatology scores were classified as responsive (n = 97) and <25% improvement as non-responsive (n = 95). Analysis of covariance, NES trajectory analysis and logistic regression models assessed diagnostic and response group differences. Baseline and longitudinal NES relationships with clinical variables were performed with Spearman correlations. Data were adjusted for age, sex, race, socioeconomic status and handedness.ResultsCognitive perceptual (COGPER) score was better than repetitive motor (REPMOT) at differentiating FEP-SZ from FEP-NSZ and distinguishing responders from non-responders. We identified significant group-specific associations between COGPER and worse GAF, positive and negative symptomatology and some of these findings persisted at 1-year assessment.ConclusionNES are an easy to administer, bedside-elicited, endophenotypic measure and could be a cost-effective clinical tool in antipsychotic-naïve FEP.

scholarly journals A Bayesian decision support sequential model for severity of illness predictors and intensive care admissions in pneumonia

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Amado Alejandro Baez ◽  
Laila Cochon ◽  
Jose Maria Nicolas
Keyword(s):  
Predictive Value ◽  
Severity Of Illness ◽  
Positive Test ◽  
Bayesian Decision ◽  
Likelihood Ratios ◽  
Negative Test ◽  
Significant Difference ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Abstract Background Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality in the USA. Our objective was to assess the predictive value on critical illness and disposition of a sequential Bayesian Model that integrates Lactate and procalcitonin (PCT) for pneumonia. Methods Sensitivity and specificity of lactate and PCT attained from pooled meta-analysis data. Likelihood ratios calculated and inserted in Bayesian/ Fagan nomogram to calculate posttest probabilities. Bayesian Diagnostic Gains (BDG) were analyzed comparing pre and post-test probability. To assess the value of integrating both PCT and Lactate in Severity of Illness Prediction we built a model that combined CURB65 with PCT as the Pre-Test markers and later integrated the Lactate Likelihood Ratio Values to generate a combined CURB 65 + Procalcitonin + Lactate Sequential value. Results The BDG model integrated a CUBR65 Scores combined with Procalcitonin (LR+ and LR-) for Pre-Test Probability Intermediate and High with Lactate Positive Likelihood Ratios. This generated for the PCT LR+ Post-test Probability (POSITIVE TEST) Posterior probability: 93% (95% CI [91,96%]) and Post Test Probability (NEGATIVE TEST) of: 17% (95% CI [15–20%]) for the Intermediate subgroup and 97% for the high risk sub-group POSITIVE TEST: Post-Test probability:97% (95% CI [95,98%]) NEGATIVE TEST: Post-test probability: 33% (95% CI [31,36%]) . ANOVA analysis for CURB 65 (alone) vs CURB 65 and PCT (LR+) vs CURB 65 and PCT (LR+) and Lactate showed a statistically significant difference (P value = 0.013). Conclusions The sequential combination of CURB 65 plus PCT with Lactate yielded statistically significant results, demonstrating a greater predictive value for severity of illness thus ICU level care.

The Brief Emotion Dysregulation Scale (BEDS): Development, validation, and implications for use

2020 ◽  
Author(s):  
Andrea M Wycoff ◽  
Sarah A Griffin ◽  
Ashley C. Helle ◽  
Timothy J Trull
Keyword(s):  
College Students ◽  
Emotion Dysregulation ◽  
Preliminary Evidence ◽  
Model Fit ◽  
Clinical Samples ◽  
Clinical Settings ◽  
Confirmatory Factor Analyses ◽  
Adequate Model ◽  
Confirmatory Factor ◽  
Future Work

Emotion dysregulation is a multi-component and transdiagnostic construct present in many types of psychopathology. Screening for the experience of emotion dysregulation will be crucial in research and clinical settings to investigate its role in the development, maintenance, and treatment of psychiatric problems. We developed the 8-item Brief Emotion Dysregulation Scale (BEDS) for screening purposes to broadly capture the experience of emotion dysregulation. Samples 1 (N=792) and 2 (N=662) included college students who completed the BEDS, and Sample 3 (N=231) included college students who completed the BEDS plus measures of related constructs. Results from exploratory and confirmatory factor analyses indicated that a one-factor solution was appropriate and provided adequate model fit, and correlations demonstrated good convergent and criterion validity. This study provides preliminary evidence for the use of the BEDS for emotion dysregulation screening, and future work should examine its validity in clinical samples.

Potential value of vestibular evoked myogenic potentials in paediatric neuropathies

2008 ◽  
Vol 18 (4) ◽  
pp. 231-237
Author(s):  
E. Jacot ◽  
S. Wiener-Vacher
Keyword(s):  
Neurological Examination ◽  
Neurological Recovery ◽  
Guillain Barre Syndrome ◽  
Vestibular Evoked Myogenic Potentials ◽  
Functional Evaluation ◽  
Testing Apparatus ◽  
Potential Value ◽  
Neurological Evaluation ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Purpose: Showing the interest of vestibular evoked myogenic potentials in paediatric neurological vestibulospinal pathology detection and followup. Materials and methods: The vestibular evoked myogenic potentials testing apparatus presented is now commonly used in ENT clinics for patients from 1 month of age. Our system and protocol permits control to evoke and select the best EMG level and makes possible a comparison of data from different sides or level of stimulation or different sessions. Normal vestibular evoked myogenic potentials latencies obtained with tone bursts were remarkably stable (P: 13 +/− 0.8 ms, N: 19.6 +/− 1.6 ms). The reported case illustrates abnormal vestibular evoked myogenic potentials latencies in neuropathy. Results: A 6 y.o. child with progressive imbalance was referred to the ENT department for vestibular functional evaluation. Abnormally long latencies in the vestibular evoked myogenic potentials and neurological examination oriented the diagnosis towards Guillain-Barre syndrome and immediate referral to a neurology department. Vestibular evoked myogenic potentials also helped to monitor the neurological recovery. Conclusion: The present case shows the potential value of vestibular evoked myogenic potentials in diagnosis and evaluation of descending brainstem pathways in neuropathies like Guillain-Barre syndrome in complement to neurological evaluation.

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