scholarly journals Identifying Poor Adherence in Outpatients with Bipolar Disorder: A Comparison of Different Measures

2021 ◽  
Author(s):  
Nidhi Chauhan ◽  
Subho Chakrabarti ◽  
Sandeep Grover
Keyword(s):  
Bipolar Disorder ◽  
Rating Scale ◽  
Correlation Coefficients ◽  
Mood Stabilizer ◽  
High Sensitivity ◽  
Serum Levels ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Self Reports ◽  
Pill Counts

Abstract Objective Unlike schizophrenia, comparisons of different methods of estimating inadequate adherence in bipolar disorder (BD) are scarce. This study compared four methods of identifying inadequate adherence among outpatients with BD. Materials and Methods Two self-reports, the Morisky Medication Adherence Questionnaire (MAQ) and the Drug Attitude Inventory (DAI-10), clinician ratings employing the Compliance Rating Scale (CRS), mood-stabilizer levels, and clinic-based pill counts were compared at intake in 106 outpatients with BD and after 6 months of follow-up (n = 75). Statistical Analysis Rates of nonadherence were determined for each method. The ability to detect inadequate adherence was based on sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR positive and LR negative). Correlation coefficients and Cohen's kappa values were used to determine the agreement between measures. Correlation coefficients were also used to evaluate the determinants of inadequate adherence Results The MAQ and the DAI-10 (cut-off score of two) yielded higher rates of nonadherence (35–47%) than the other methods. They were better at detecting adherence (specificity, 34–42%; PPV, 40–44%; and LR negative, 0.70–0.96) than other measures and had moderate ability to identify nonadherence compared with them (sensitivity, 63–73%; NPV, 54–70%; and LR positive, 1.02–1.16). They were associated with several established predictors of nonadherence. The MAQ and DAI-10 scores and the MAQ and CRS scores were modestly correlated. Multivariate analysis showed that 20% of the variance in the DAI-10 scores was explained by the MAQ scores. Despite their low yield, serum levels had a high sensitivity (88%) and higher accuracy (55%) in identifying inadequate adherence. CRS ratings and pill counts had high sensitivity but low specificity to detect inadequate adherence. Conclusion Self-reports appeared to be the most efficient method of ascertaining inadequate adherence among outpatients with BD. However, since none of the measures were adequate by themselves, a combination of different measures is more likely to maximize the chances of identifying inadequate adherence among these patients.

scholarly journals POS1418 REALIZING EARLY RECOGNITION OF ARTHRITIS IN TIMES OF INCREASED TELEMEDICINE: THE VALUE OF PATIENT-REPORTED SWOLLEN JOINTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 992.1-992
Author(s):  
C. Rogier ◽  
B. Van Dijk ◽  
E. Brouwer ◽  
P. De Jong ◽  
A. Van der Helm - van Mil
Keyword(s):  
Early Recognition ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Self Report ◽  
Symptom Duration ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Patient Level ◽  
Patient Reported ◽  
Joint Examination

Background:Early diagnosis and management of patients with inflammatory arthritis(IA) are critical to improve long-term patient-outcomes. Assessment of joint swelling at joint examination is the reference of IA-identification; early access clinics are constructed to promote this early recognition of IA. However, due to the COVID-19 pandemic the face-to-face capacity of such services is severely reduced. The accuracy of patient-reported swelling in comparison to joint examination has been extensively evaluated in established RA (ρ 0.31-0.67), but not in patients suspected for IA.[1]Objectives:To promote evidence based care in the era of telemedicine, we determined the accuracy of patient-reported joint swelling for actual presence of IA in persons suspected of IA by general practitioners(GP).Methods:Data from two Dutch Early Arthritis Recognition Clinics were studied. These are screening clinics (1.5-lines-setting) where GPs send patients in case of doubt on IA. At this clinic patients were asked to mark the presence of swollen joints on a mannequin with 52 joints. For this study the DIP joints and the metatarsal joints were excluded and, therefore, a total of 42 joints were assessed for self-reported joint swelling. Clinically apparent IA of ≥1 joint determined by the physician was the reference to calculate sensitivity, specificity, positive and negative likelihood ratios (LR+,LR-), and positive and negative predictive values (PPV, NPV) on patient-level. Pearson correlation coefficients(ρ) were determined. Predictive values depend on the prevalence of a disease in a population. Because the prevalence of IA in a 1.5-lines-setting will differ from a primary care setting, post-test probabilities of IA were estimated for two lower prior-test probabilities as example, namely 20% (estimated probability in patients GPs belief IA is likely) and 2% (prior-test probability with less preselection by GPs), using likelihood ratios and nomograms.Results:A total of 1637 consecutive patients were studied. Median symptom duration was 13 weeks. 76% of patients marked ≥1swollen joint at the mannequin. 41% of patients had ≥1swollen joint at examination by rheumatologists. ρ was 0.20(patient-level)-0.26(joint-level).The sensitivity of patients-reported joint swelling was high, 87%, indicating that the majority of patients with IA had marked swelling on the mannequin. However the specificity was 31%, indicating that 69% of persons without IA had also done so. The LR+ was 1.25; the LR- 0.43. The PPV was 46%, the NPV 77%. Thus the PPV increased hardly (from 41% to 46%) and the NPV somewhat (from 59% to 77%). Also in settings with prior-test probabilities of 20% and 2%, estimated PPVs (from respectively 20% and 2% to 24% and 2%) and NPVs (from respectively 80% and 98% to 90% and 99%) hardly increased.Conclusion:Patient-reported joint swelling had little value in distinguishing patients with/without IA for different prior-test probabilities, and is less valuable in comparison to self-reported flare detection in established RA.References:[1]Barton JL, Criswell LA, Kaiser R, et al. Systematic review and metaanalysis of patient self-report versus trained assessor joint counts in rheumatoid arthritis. J Rheumatol 2009;36:2635-2641.Disclosure of Interests:None declared

Lithium and valproate combination: Therapeutic strategies in a sample of patients with bipolar disorder

2011 ◽  
Vol 26 (S2) ◽  
pp. 236-236
Author(s):  
M. Muti ◽  
I. Pergentini ◽  
M. Corsi ◽  
C. Viaggi ◽  
A. Caramelli ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Side Effects ◽  
Combination Therapy ◽  
Glycogen Synthase ◽  
Single Agent ◽  
Mood Stabilizer ◽  
Serum Levels ◽  
Psychiatric Clinic ◽  
Comparison Groups ◽  
Prevention Of Relapse

IntroductionLithium is the agent that has shown more efficacy for the treatment of Bipolar Disorder (BD), anyway a single agent isn’t effective to control all aspects of the syndrome.The mood-stabilizer frequently used, in combination with Lithium, is Valproate which presents different methabolism and side effects. Further both molecules are glycogen synthase kinase-3 (GSK-3b) inhibitors and have synergistic neuroprotective action.ObjectivesWe underline the need to better investigate Lithium and Valproate combination therapy in BD.AimsObservation of Lithium and Valproate combination therapy in a sample of patients with BD, considering doses and serum levels.Methods56 patients with BD (mean age 38 ± 0,02), followed at the day hospital of the Psychiatric Clinic, University of Pisa, were studied. Serum levels evaluated at the Section of Pharmacology, Department of Neuroscience, University of Pisa.ResultsWe identified 5 comparison groups depending on the dose intake of Lithium (11 subjects: 300 mg /die, 9: 450 mg/die, 19: 600 mg/die, 7: 750 mg/die, 10: 900 mg/die) with increased serum levels of the medication (0.27 mEq/l, 0.37 mEq/l, 0.50 mEq/l, 0.52 mEq/l, 0,70 mEq/l). There are not significant differences between groups related to both, the mean dose intake of Valproate (772 mg/die, 744.4 mg/die, 867.5 mg/die, 821.4 mg/die, 845 mg/die) and its serum levels (45.2 mg/L, 46.6 mg/L, 53.2 mg/L, 47.4 mg/L, 48.4 mg/L).ConclusionsThis study aims to identify the effective dose of Lithium in combination with Valproate able to determine the prevention of relapse in BD patients. The use of the lower dose of Lithium maintaining therapeutic effectivness, means reducing side effects, toxicity and the need for constant monitoring.

scholarly journals Clinical Usefulness of Retropulsion Tests in Persons with Mild to Moderate Parkinson’s Disease

2021 ◽  
Vol 18 (23) ◽  
pp. 12325
Author(s):  
Beata Lindholm ◽  
Erika Franzén ◽  
Wojciech Duzynski ◽  
Per Odin ◽  
Peter Hagell
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
Clinical Usefulness ◽  
Youden Index ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Time Points ◽  
Increased Risk ◽  
Near Falls

People with Parkinson’s disease (PwPD) have an increased risk for falls and near falls. They have particular difficulties with maintaining balance against an external perturbation, and several retropulsion tests exist. The Unified PD Rating Scale item 30 (UPDRS30) is the most common, involving an expected shoulder pull. Others recommend using an unexpected shoulder pull, e.g., the Nutt Retropulsion Test (NRT). We aimed to evaluate the clinical usefulness of these tests for detecting future fallers. By using two different golden standards related to self-reported prospective falls and near falls over 6 months following two different time points with 3.5 years between, we estimated sensitivity/specificity, Youden index, predictive values, and likelihood ratios for each test. The different time points yielded a different prevalence of falls and near falls, as well as different predictive values. When comparing the performance of the NRT and UPDRS30 for detecting future fallers, we found that the NRT consistently performed better than UPDRS30. However, neither test exhibited optimal performance in terms of predictive values and associated likelihood ratios. Our findings speak against using either of these tests as a single assessment for this purpose and support previous recommendations of using a multifactorial approach when targeting balance problems in PwPD.

scholarly journals Blood pressure-to-height ratio for diagnosing hypertension in adolescents

2017 ◽  
Vol 57 (2) ◽  
pp. 84
Author(s):  
Kristina Ambarita ◽  
Oke Rina Ramayani ◽  
Munar Lubis ◽  
Isti Ilmiati Fujiati ◽  
Rafita Ramayati ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Children And Adolescents ◽  
High Blood Pressure ◽  
Screening Tool ◽  
High Sensitivity ◽  
Likelihood Ratios ◽  
Height Ratio ◽  
Cross Sectional ◽  
Predictive Values ◽  
National High Blood Pressure

Background Diagnosing hypertension in children and adolescents is not always straightforward. The blood pressure-to-height ratio (BPHR) has been reported as a screening tool for diagnosing hypertension.Objective To evaluate the diagnostic value of blood pressure-to-height ratio for evaluating hypertension in adolescents.Methods A cross-sectional study was conducted among 432 healthy adolescents aged 12-17 years in Singkuang, North Sumatera from April to May 2016. Blood pressure tables from the National High Blood Pressure Education Program (NHBPEP) Working Group on High Blood Pressure in Children and Adolescents were used as our standard of comparison. Sex-specific systolic and diastolic blood pressure-to-height ratios (SBPHR and DBPHR) were calculated. ROC curve analyses were performed to assess the accuracy of BPHR for discriminating between hypertensive and non-hypertensive adolescents. Optimal thresholds of BPHR were determined and validated using 2x2 table analyses.Results The accuracies of BPHR for diagnosing hypertension were > 90% (P<0.001), for both males and females. Optimal SBPHR and DBPHR thresholds for defining hypertension were 0.787 and 0.507 in boys, respectively, and 0.836 and 0.541 in girls, respectively. The sensitivities of SBPHR and DBPHR in both sexes were all >93%, and specificities in both sexes were all >81%. Positive predictive values for SBPHR and DBPHR were 38.7% and 45.2% in boys, respectively; and 55.9% and 42.4% in girls, respectively; negative predictive values in both sexes were all >97%, positive likelihood ratios in both sexes were all >5, and negative likelihood ratios in both sexes were all <1.Conclusion Blood pressure-to-height ratio is a simple screening tool with high sensitivity and specificity for diagnosing hypertension in adolescents.

scholarly journals Dizziness Handicap Inventory in Clinical Evaluation of Dizzy Patients

2021 ◽  
Vol 18 (5) ◽  
pp. 2210
Author(s):  
Ewa Zamyslowska-Szmytke ◽  
Piotr Politanski ◽  
Magdalena Jozefowicz-Korczynska
Keyword(s):  
Correlation Coefficients ◽  
Principal Component ◽  
High Sensitivity ◽  
Vestibular Dysfunction ◽  
Psychological Status ◽  
Dizziness Handicap Inventory ◽  
Predictive Values ◽  
Highly Correlated ◽  
Psychogenic Dizziness ◽  
Clinical Conditions

(1) Objectives: The evaluation of dizzy patients is difficult due to nonspecific symptoms that require a multi-specialist approach. The Dizziness Handicap Inventory (DHI) is widely used in the assessment of dizziness-related disability, but its clinical efficacy needs further expansion. The aim of this study was to identify the subscales of DHI that may correlate with some vestibular or nonvestibular dysfunctions. (2) Material and methods: This observational study included 343 dizzy patients with one of the following clinical conditions: Vestibular impairment noncompensated or compensated, central or bilateral, benign paroxysmal positional vertigo (BPPV), migraine and psychogenic dizziness. Principal component analysis was used to examine the factorial structure of the questionnaire. (3) Results: The DHI questionnaire total scoring and its vestibular subscale distinguished between patients with compensated and uncompensated vestibular dysfunction with positive predictive values of 76% and 79%, respectively. The DHI items composing the F3 (positional) subscale revealed the highest scoring in the BPPV group with 75% sensitivity and 92% negative predictive value (NPV) in reference to Dix–Hallpike tests. The DHI total score and the subscales scores correlated with anxiety-depression, and the highest correlation coefficients were calculated for vestibular (F2 0.56) and anxiety (F5 0.51) subscales. (4) Conclusions: Our analysis revealed that the DHI vestibular subscale distinguishes between patients with compensated and uncompensated vestibular dysfunction. The positional subscale showed the highest scoring in the BPPV group with high sensitivity and low specificity of the test. The DHI is highly correlated with patients’ psychological status.

scholarly journals Hsa_circ_001659 serves as a diagnostic and prognostic biomarker for colorectal cancer

2020 ◽  
Author(s):  
Baoyu He ◽  
Wei Chao ◽  
Zhizhuo Huang ◽  
Jianchao Zeng ◽  
Jie Yang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Epithelial Mesenchymal Transition ◽  
Early Stage ◽  
Serum Levels ◽  
Gene Expression Omnibus ◽  
Circular Rnas ◽  
Likelihood Ratios ◽  
Early Stage Disease ◽  
Predictive Values ◽  
Mesenchymal Transition

Abstract Background: Colorectal cancer (CRC) is prevalent worldwide and novel diagnostic and prognostic biomarkers are needed to improve precision medicine. Circulating circular RNAs (circRNAs) are currently being considered as emerging tumor biomarkers. Methods: Candidate circRNA was selected by integrating analysis of Gene Expression Omnibus (GEO) database using GEO2R program. The expression data of serum circ_001659 were obtained from the quantitative real-time polymerase chain reaction (qRT-PCR). Receiver operating characteristic curves were applied to evaluate the clinical applications of circ_001659. Finally, biological functions and potential mechanisms of circ_001659 in tumor progression were investigated in CRC progression. Results: The results showed that the diagnostic performance of serum circ_001659 were excellent for CRC detection. The predictive values and likelihood ratios were satisfactory for the diagnosis of CRC, including patients in early-stage disease or patients with carcinoembryonic antigen (CEA)-negative status. Serum levels of circ_001659 declined significantly 3 months after surgery in both preoperative CEA-positive and CEA-negative patients. Functionally, circ_001659 influenced tumor cell metastasis via regulating epithelial-mesenchymal transition (EMT) and cytoskeleton organization. Conclusion: Our findings demonstrate that circ_001659 could be a useful serum biomarker for CRC diagnosis and prognosis. Targeting circ_001659 and its pathway may be meaningful for treating patients with CRC.

scholarly journals An Evaluation of the Arcus Corneae For Age Estimation

2019 ◽  
Vol 9 (3-4) ◽  
pp. 155-162
Author(s):  
Boonsak Hanterdsith
Keyword(s):  
Predictive Value ◽  
Interobserver Reliability ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Likelihood Ratios ◽  
Chi Square ◽  
Cross Sectional ◽  
Predictive Values ◽  
Sensitivity Specificity

Although the arcus corneae (AC) has long been used as an age indicator for forensic purposes, its diagnostic value has not been evaluated. To evaluate the AC as a predictor of chronological age, the author has studied the correlation of AC with respect to age of the deceased. A cross-sectional study was conducted of 342 Thai corpses at the Maharat Nakhon Ratchasima Hospital, Thailand. AC was graded into three levels: no AC, incomplete ring, and complete ring. One-way analysis of variance, chi-square test, binomial logistic regression, sensitivity, specificity, predictive values, and likelihood ratios were used for analysis. The Cohen’s kappa was used to determine the intraobserver and interobserver reliability. The prevalence of AC and the probability of complete AC were significant higher in corpses aged 60 years and above than in those under 60 years. Consequently, this study confirmed that the prevalence of AC was significantly correlated with the age of Thai individuals. If the complete AC is used as an indicator of age of 60 years and above, complete AC has high sensitivity (92.56%) but low specificity (72.85%), low positive predictive value (65.12%), but high negative predictive value (94.71%). For diagnostic value, the presence of AC can be used for age screening but not for absolute confirmation. The absence of AC indicates young age, incomplete AC indicates middle age, and complete AC indicates old age. The high intraobserver and interobserver reliability provides assurance of the value of AC as a means to estimate personal age.

Validation of the Ottawa Ankle Rules for Acute Foot and Ankle Injuries

2016 ◽  
Vol 25 (1) ◽  
pp. 48-51 ◽  
Author(s):  
Shannon David ◽  
Kim Gray ◽  
Jeffrey A. Russell ◽  
Chad Starkey
Keyword(s):  
High Sensitivity ◽  
Clinical Decision ◽  
Ankle Injuries ◽  
Evaluation Tool ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Negative Finding ◽  
Radiographic Findings ◽  
Acute Setting ◽  
Ottawa Ankle Rules

The original and modified Ottawa Ankle Rules (OARs) were developed as clinical decision rules for use in emergency departments. However, the OARs have not been evaluated as an acute clinical evaluation tool.Objective:To evaluate the measures of diagnostic accuracy of the OARs in the acute setting.Methods:The OARs were applied to all appropriate ankle injuries at 2 colleges (athletics and club sports) and 21 high schools. The outcomes of OARs, diagnosis, and decision for referral were collected by the athletic trainers (ATs) at each of the locations. Contingency tables were created for evaluations completed within 1 h for which radiographs were obtained. From these data the sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values were calculated.Results:The OARs met the criteria for radiographs in 100 of the 124 cases, of which 38 were actually referred for imaging. Based on radiographic findings in an acute setting, the OARs (n = 38) had a high sensitivity (.88) and are good predictors to rule out the presence of a fracture. Low specificity (0.00) results led to a high number of false positives and low positive predictive values (.18).Conclusion:When applied during the first hour after injury the OARs significantly overestimate the need for radiographs. However, a negative finding rules out the need to obtain radiographs. It appears the AT’s decision making based on the totality of the examination findings is the best filter in determining referral for radiographs.

Evaluation of a new automated panel of assays for the detection of anti-PF4/heparin antibodies in patients suspected of having heparin-induced thrombocytopenia

2010 ◽  
Vol 104 (08) ◽  
pp. 402-409 ◽  
Author(s):  
Michela Cini ◽  
Caterina Pili ◽  
Ottavio Boggian ◽  
Mirella Frascaro ◽  
Gualtiero Palareti ◽  
...  
Keyword(s):  
False Negative ◽  
High Sensitivity ◽  
Turnaround Time ◽  
Likelihood Ratios ◽  
Assay Sensitivity ◽  
Predictive Values ◽  
Heparin Induced Thrombocytopenia ◽  
Thrombotic Complications ◽  
Sample Testing ◽  
Immunologic Assays

SummaryHeparin-induced thrombocytopenia (HIT) is a life-threatening complication of heparin treatment; the prognosis depends on early and accurate diagnosis, and prompt start of alternative anticoagulants. Because of high sensitivity, the commercially available immunologic assays are widely used, though not suited to be run on single samples and with a turnaround time of 2–3 hours. We evaluated two new, rapid, automated, semi-quantitative chemiluminescent immunoassays in HIT suspected patients: HemosIL® AcuStar HIT-IgG(PF4-H) (specific for IgG anti- PF4/heparin antibodies) and HemosIL® AcuStar HIT-Ab(PF4-H) (detecting IgG, IgM and IgA anti-PF4/heparin antibodies) (both from Instrumentation Laboratory). A total of 102 patients with suspected HIT were included; HIT was diagnosed in 17 (16.7%). No false negative cases were observed using either the HemosIL AcuStar HIT-IgG(PF4-H) or the HITAb(PF4-H) assay (sensitivity and negative predictive values = 100%; negative likelihood ratios <0.01). The specificity was higher for the He-mosIL AcuStar HIT-IgG(PF4-H) in comparison with that of the HemosIL AcuStar HIT-Ab(PF4-H) (96.5% vs. 81.2%). Higher values of the HemosIL AcuStar HIT-IgG(PF4-H) were associated with increased probability of HIT. Patients with confirmed HIT and thrombotic complications had significantly higher levels of HemosIL AcuStar HIT-IgG(PF4-H) than those without thrombotic complications. The HemosIL AcuStar HIT-IgG(PF4-H) and HIT-Ab(PF4-H) assays showed a very high sensitivity, and therefore they can reliably be used to rule out HIT in suspected patients. The diagnostic specificity was greatly increased by using the HemosIL AcuStar HITIgG(PF4-H). Both the assays are reproducible (CVs <6%), rapid (turnaround time 30 minutes), automated, and semi-quantitative, and they can be run for single sample testing.

scholarly journals Hsa_circ_001659 Serves as a Diagnostic and Prognostic Biomarker for Colorectal Cancer

2021 ◽  
Author(s):  
Baoyu He ◽  
Wei Chao ◽  
Zhizhuo Huang ◽  
Jianchao Zeng ◽  
Jie Yang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Epithelial Mesenchymal Transition ◽  
Early Stage ◽  
Serum Levels ◽  
Gene Expression Omnibus ◽  
Circular Rnas ◽  
Likelihood Ratios ◽  
Early Stage Disease ◽  
Predictive Values ◽  
Mesenchymal Transition

Abstract Background: Colorectal cancer (CRC) is prevalent worldwide and novel diagnostic and prognostic biomarkers are needed to improve precision medicine. Circulating circular RNAs (circRNAs) are currently being considered as emerging tumor biomarkers. Methods: Candidate circRNA was selected by integrating analysis of Gene Expression Omnibus (GEO) database using GEO2R program. The expression data of serum circ_001659 were obtained from the quantitative real-time polymerase chain reaction (qRT-PCR). Receiver operating characteristic curves were applied to evaluate the clinical applications of circ_001659. Finally, biological functions and potential mechanisms of circ_001659 in tumor progression were investigated in CRC progression. Results: The results showed that the diagnostic performance of serum circ_001659 were excellent for CRC detection. The predictive values and likelihood ratios were satisfactory for the diagnosis of CRC, including patients in early-stage disease or patients with carcinoembryonic antigen (CEA)-negative status. Serum levels of circ_001659 declined significantly 3 months after surgery in both preoperative CEA-positive and CEA-negative patients. Functionally, circ_001659 influenced tumor cell metastasis via regulating epithelial-mesenchymal transition (EMT) and cytoskeleton organization. Conclusion: Our findings demonstrate that circ_001659 could be a useful serum biomarker for CRC diagnosis and prognosis. Targeting circ_001659 and its pathway may be meaningful for treating patients with CRC.

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