scholarly journals The Use of Different Muscle Assessment Techniques to Assess Validity of Global Leadership Initiative on Malnutrition (GLIM)

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1273-1273
Author(s):  
Dayana El Chaar ◽  
Cosette Fakih El Khoury ◽  
Krystel Ouaijan ◽  
Lama Mattar
Keyword(s):  
At Risk ◽  
Food Intake ◽  
Handgrip Strength ◽  
High Sensitivity ◽  
High Specificity ◽  
Global Leadership ◽  
Assessment Tools ◽  
Muscle Loss ◽  
Predictive Values ◽  
Assessment Techniques

Abstract Objectives To assess which combination of indicators in the Global Leadership Initiative on Malnutrition (GLIM) diagnostic tool better predicts malnutrition. Additionally, to compare the validity of GLIM upon the use of different muscle assessment techniques for the assessment of muscle loss. Methods Nutritional screening was performed through the Nutrition Risk Screening-2002 (NRS-2002) or the Mini-Nutrition Assessment-Full Form (MNA-FF). Nutritionally at-risk patients were assessed for malnutrition using the GLIM criterion. Fat free muscle index (FFMI), nutrition focused physical examination (NFPE) and handgrip strength (HG) were used to identify muscle loss. Sensitivity, specificity, positive and negative predictive values were calculated for GLIM with each of the three muscle assessment tools. Results 579 patients were screened for malnutrition and 121(20.90%) patients were considered nutritionally at risk. GLIM criterion showed close percentages of malnourished patients: 117(20.21%), 110(19.0%) and 110 (19.0%) when using NFPE, FFMI, and HG respectively. With three different muscle assessment techniques, 10 different combinations of indicators in GLIM were retrieved. The combination of muscle loss, assessed through NFPE, with either one of the two etiologic criteria yielded the highest numbers of malnourished patients among all three techniques [NFPE + reduced food intake/assimilation: 113(19.52%) and NFPE + Inflammation: 117(20.21%)], while the use of FFMI resulted in the lowest [FFMI + reduced food intake/assimilation: 37(6.39%) and FFMI + Inflammation: 40(6.91%)]. All three tools, GLIM + NFPE, GLIM + FFMI, and GLIM + HG reported high specificity [98.9% (97.45–99.64), 99.1% (97.76–99.76) and 99.1% (97.78–99.76) respectively]. However, results revealed moderate sensitivity for GLIM + FFMI [89.8% (82.91–94.63)]and GLIM + HG [89.1% (82.04–94.05)] yet a high sensitivity for GLIM + NFPE [93.3% (87.29–97.08)]. Conclusions The combination of NFPE with either of the etiologic criteria identified more malnourished patients than the combinations including FFMI or HG. A high degree of validity was reported for all three muscle assessment tools in GLIM criterion. Funding Sources None.

Analysis of emergency department prediction tools in evaluating febrile young infants at risk for serious infections

2019 ◽  
pp. emermed-2018-208210 ◽  
Author(s):  
Sarah Hui Wen Yao ◽  
Gene Yong-Kwang Ong ◽  
Ian K Maconochie ◽  
Khai Pin Lee ◽  
Shu-Ling Chong
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Clinical Assessment ◽  
Low Risk ◽  
Assessment Tools ◽  
Predictive Values ◽  
Nice Guideline ◽  
Risk Criteria ◽  
Young Infants ◽  
Serious Infections

ObjectiveFebrile infants≤3 months old constitute a vulnerable group at risk of serious infections (SI). We aimed to (1) study the test performance of two clinical assessment tools—the National Institute for Health and Care Excellence (NICE) Traffic Light System and Severity Index Score (SIS) in predicting SI among all febrile young infants and (2) evaluate the performance of three low-risk criteria—the Rochester Criteria (RC), Philadelphia Criteria (PC) and Boston Criteria (BC) among well-looking febrile infants.MethodsA retrospective validation study was conducted. Serious illness included both bacterial and serious viral illness such as meningitis and encephalitis. We included febrile infants≤3 months old presenting to a paediatric emergency department in Singapore between March 2015 and February 2016. Infants were assigned to high-risk and low-risk groups for SI according to each of the five tools. We compared the performance of the NICE guideline and SIS at initial clinical assessment for all infants and the low-risk criteria—RC, PC and BC—among well-looking infants. We presented their performance using sensitivity, specificity, positive, negative predictive values and likelihood ratios.ResultsOf 1057 infants analysed, 326 (30.8%) were diagnosed with SI. The NICE guideline had an overall sensitivity of 93.3% (95% CI 90.0 to 95.7), while the SIS had a sensitivity of 79.1% (95% CI 74.3 to 83.4). The incidence of SI was similar among infants who were well-looking and those who were not. Among the low-risk criteria, the RC performed with the highest sensitivity in infants aged 0–28 days (98.2%, 95% CI 90.3% to 100.0%) and 29–60 days (92.4%, 95% CI 86.0% to 96.5%), while the PC performed best in infants aged 61–90 days (100.0%, 95% CI 95.4% to 100.0%).ConclusionsThe NICE guideline achieved high sensitivity in our study population, and the RC had the highest sensitivity in predicting for SI among well-appearing febrile infants. Prospective validation is required.

scholarly journals Malnutrition Screening and Assessment in the Cancer Care Ambulatory Setting: Mortality Predictability and Validity of the Patient-Generated Subjective Global Assessment Short form (PG-SGA SF) and the GLIM Criteria

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2287 ◽  
Author(s):  
Lynette M. De Groot ◽  
Gahee Lee ◽  
Antoinette Ackerie ◽  
Barbara S. van der Meij
Keyword(s):  
Mortality Risk ◽  
Cancer Care ◽  
Global Assessment ◽  
Short Form ◽  
Handgrip Strength ◽  
Assessment Tools ◽  
Ambulatory Setting ◽  
Severe Malnutrition ◽  
Subjective Global Assessment ◽  
Predictive Values

Background: A valid malnutrition screening tool (MST) is essential to provide timely nutrition support in ambulatory cancer care settings. The aim of this study is to investigate the validity of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) and the new Global Leadership Initiative on Malnutrition (GLIM) criteria as compared to the reference standard, the Patient-Generated Subjective Global Assessment (PG-SGA). Methods: Cross-sectional observational study including 246 adult ambulatory patients with cancer receiving in-chair intravenous treatment at a cancer care centre in Australia. Anthropometrics, handgrip strength and patient descriptive data were assessed. Nutritional risk was identified using MST and PG-SGA SF, nutritional status using PG-SGA and GLIM. Sensitivity (Se), specificity (Sp), positive and negative predictive values and kappa (k) were analysed. Associations between malnutrition and 1-year mortality were investigated by Cox survival analyses. Results: A PG-SGA SF cut-off score ≥5 had the highest agreement when compared with the PG-SGA (Se: 89%, Sp: 80%, k = 0.49, moderate agreement). Malnutrition risk (PG-SGA SF ≥ 5) was 31% vs. 24% (MST). For malnutrition according to GLIM, the Se was 76% and Sp was 73% (k = 0.32, fair agreement) when compared to PG-SGA. The addition of handgrip strength to PG-SGA SF or GLIM did not improve Se, Sp or agreement. Of 100 patients who provided feedback, 97% of patients found the PG-SGA SF questions easy to understand, and 81% reported that it did not take too long to complete. PG-SGA SF ≥ 5 and severe malnutrition by GLIM were associated with 1-year mortality risk. Conclusions: The PG-SGA SF and GLIM criteria are accurate, sensitive and specific malnutrition screening and assessment tools in the ambulatory cancer care setting. The addition of handgrip strength tests did not improve the recognition of malnutrition or mortality risk.

scholarly journals Impaired gas exchange: accuracy of defining characteristics in children with acute respiratory infection

2015 ◽  
Vol 23 (3) ◽  
pp. 491-499 ◽  
Author(s):  
Lívia Maia Pascoal ◽  
Marcos Venícios de Oliveira Lopes ◽  
Daniel Bruno Resende Chaves ◽  
Beatriz Amorim Beltrão ◽  
Viviane Martins da Silva ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Skin Color ◽  
Acute Respiratory Infection ◽  
Predictive Ability ◽  
High Sensitivity ◽  
High Specificity ◽  
Predictive Values ◽  
Nursing Diagnosis ◽  
Consecutive Period ◽  
Abnormal Breathing

OBJECTIVE: to analyze the accuracy of the defining characteristics of the Impaired gas exchange nursing diagnosis in children with acute respiratory infection.METHOD: open prospective cohort study conducted with 136 children monitored for a consecutive period of at least six days and not more than ten days. An instrument based on the defining characteristics of the Impaired gas exchange diagnosis and on literature addressing pulmonary assessment was used to collect data. The accuracy means of all the defining characteristics under study were computed.RESULTS: the Impaired gas exchange diagnosis was present in 42.6% of the children in the first assessment. Hypoxemia was the characteristic that presented the best measures of accuracy. Abnormal breathing presented high sensitivity, while restlessness, cyanosis, and abnormal skin color showed high specificity. All the characteristics presented negative predictive values of 70% and cyanosis stood out by its high positive predictive value.CONCLUSION: hypoxemia was the defining characteristic that presented the best predictive ability to determine Impaired gas exchange. Studies of this nature enable nurses to minimize variability in clinical situations presented by the patient and to identify more precisely the nursing diagnosis that represents the patient's true clinical condition.

scholarly journals Reliability of Cobas Amplicor PCR test in detection of Mycobacterium tuberculosis in respiratory and nonorespiratory specimens

2009 ◽  
Vol 66 (12) ◽  
pp. 992-997
Author(s):  
Zorica Lepsanovic ◽  
Dejana Savic ◽  
Branka Tomanovic
Keyword(s):  
Mycobacterium Tuberculosis ◽  
High Sensitivity ◽  
High Specificity ◽  
Diagnostic Methods ◽  
Nucleic Acid Amplification ◽  
Culture Methods ◽  
Predictive Values ◽  
Polymerase Chain ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Background/Aim. Traditional methods for detection of mycobacteria, such as microscopic examination for the presence of acid-fast bacilli and isolation of the organism by culture, have either a low sensitivity and/or specificity, or take weeks before a definite result is available. Molecular methods, especially those based on nucleic acid amplification, are rapid diagnostic methods which combine high sensitivity and high specificity. The aim of this study was to determine the usefulness of the Cobas Amplicor Mycobacterium tuberculosis polymerase chain reaction (CAPCR) assay in detecting the tuberculosis cause in respiratory and nonrespiratory specimens (compared to culture). Methods. Specimens were decontaminated by the N-acetyl-L-cystein- NaOH method. A 500 ?L aliquot of the processed specimen were used for inoculation of L?wenstein-Jensen (L-J) slants, a drop for acid-fast staining, and 100 ?L for PCR. The Cobas Amplicor PCR was performed according to the manufacturer's instructions. Results. A total of 110 respiratory and 355 nonrespiratory specimens were investigated. After resolving discrepancies by reviewing medical history, overall sensitivity, specificity, and positive and negative predictive values for CA-PCR assay compared to culture, were 83%, 100%, 100%, and 96.8%, respectively. In comparison, they were 50%, 99.7%, 87.5%, and 98%, respectively, for the nonrespiratory specimens. The inhibition rate was 2.8% for respiratory, and 7.6% for nonrespiratory specimens. Conclusion. CA-PCR is a reliable assay that enables specialists to start treatment promptly on a positive test result. Lower value for specificity in a group of nonrespiratory specimens is a consequence of an extremely small number of mycobacteria in some of them.

Evaluation of the clinical usefulness of a chemiluminometric method for measuring creatine kinase MB

1990 ◽  
Vol 36 (10) ◽  
pp. 1809-1811 ◽  
Author(s):  
J R Pearson ◽  
F Carrea
Keyword(s):  
Creatine Kinase ◽  
Predictive Value ◽  
Characteristic Curve ◽  
High Sensitivity ◽  
High Specificity ◽  
Receiver Operator Characteristic Curve ◽  
Diagnostic Efficiency ◽  
Predictive Values ◽  
Creatine Kinase Mb ◽  
Rule Out

Abstract The use of creatine kinase isoenzymes (CK-MB) in the diagnosis of acute myocardial infarction (AMI) is well established. We evaluated the use of a new chemiluminometric method (CK-Ciba) for measuring CK-MB by calculating its sensitivity, specificity, positive and negative predictive values, and diagnostic efficiency for diagnosing AMI. We tested 633 samples from 229 patients within 4 h of receipt. The patients were divided into four groups: (1) patients who had an AMI, (2) patients who had AMI ruled out, (3) patients who had CK-MB measured for reasons other than to rule out AMI, and (4) patients who had only one sample drawn. Only patients in Groups 1 and 2 were used in the study. AMI was diagnosed by a cardiologist. The prevalence of AMI in our population was 0.18. A receiver-operator characteristic curve was used to establish optimal values for identifying AMI with the CK-Ciba results: CK-MB greater than or equal to 10 micrograms/L and a CK-MB index of greater than or equal to 3.0 (micrograms of CK-MB per U of CK x 100). Using these values, we calculated a sensitivity of 1.00, specificity of 0.97, positive predictive value of 0.87, negative predictive value of 1.00, and a diagnostic efficiency of 0.97. We conclude that the CK-Ciba method has high sensitivity, high specificity, and good predictive values for CK-MB and is appropriate to use to rule out AMI.

scholarly journals Time to step up 4 flights of stairs gives relevant information on exercise testing performance and results

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
JC Peteiro Vazquez ◽  
A Bouzas-Mosquera ◽  
C Rivadulla-Varela ◽  
C Barbeito-Caamano ◽  
JM Vazquez-Rodriguez
Keyword(s):  
Exercise Capacity ◽  
Exercise Testing ◽  
Test Performance ◽  
Predictive Value ◽  
Area Under The Curve ◽  
High Sensitivity ◽  
High Specificity ◽  
Cardiac Events ◽  
Predictive Values ◽  
Metabolic Equivalents

Abstract Funding Acknowledgements Type of funding sources: None. Background The achievement of a maximal workload of 10 metabolic equivalents (METs) is associated to good outcome with hard cardiac events of just around 1%/year. However, there is no much information on common daily exercises that can be quantitatively measured and give information about this exercise performance. We aimed to assess the capacity of stepping up stairs in patients submitted for an exercise testing (ExT). Methods A total of 165 consecutive ambulatory patients submitted for a clinically indicated ExT with ECG (ExT-ECG, n = 15) or echocardiography (ExT-E, n = 150) were included. At least 15 minutes after the test patients were asked to step up 4 flights of stairs (60 stairs) at fast pace without stopping but also without running and the time to do it was counted. Results Patients who achieved 10 METs during exercise (n = 69) made the stairs test in 46 ± 11 secs, those who achieved 8-10 METs (n = 37) in 58 ± 21 secs, and those who achieved <8 METs (n = 59) made it in 82 ± 41 secs (p < 0.001). Correlation between METs and stairs time test was 0.53 (Figure 1). The area under the curve ROC of stairs time for predicting an achievement of 10 METs was 0.79 (95% CI= 0.72-0.86, p < 0.001). A cut off value of 60 secs had high sensitivity (94%) and negative predictive value for 10 METs (93%) although specificity and positive predictive values were of 53% and 59%, respectively. A cut-off value of 90 secs had low sensitivity (34%) but high specificity (96%) and positive predictive value (83%) for predicting <8 METs. Abnormal results were seen in 58% of patients with limited exercise capacity, 30% with intermediate exercise capacity, and 29% with good exercise capacity (p = 0.002); and in 32% of patients that did the stairs test in at least 60 secs in comparison with 52% of those that lasted between 61-89 secs and 58% of those that lasted more (p = 0.018). Conclusions Most subjects able to step up 4 flights of stairs in 45 secs will perform well during exercise testing. On the contrary, those unable to make the stairs test in 1 and a half minutes are expected to have bad functional capacity and worse exercise test performance. Abstract Figure.

scholarly journals Performance Characteristics of Four High-Throughput Immunoassays for Detection of IgG Antibodies against SARS-CoV-2

2020 ◽  
Vol 58 (8) ◽  
Author(s):  
Elitza S. Theel ◽  
Julie Harring ◽  
Heather Hilgart ◽  
Dane Granger
Keyword(s):  
High Throughput ◽  
High Sensitivity ◽  
High Specificity ◽  
Cross Reactivity ◽  
Clinical Diagnostics ◽  
Igg Antibodies ◽  
Serum Samples ◽  
Predictive Values ◽  
Serologic Tests ◽  
Convalescent Phase

ABSTRACT The role of serologic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in both the clinical and public health settings, will continue to evolve as we gain increasing insight into our immune response to the virus. Here, we evaluated four high-throughput serologic tests for detection of anti-SARS-CoV-2 IgG antibodies, from Abbott Laboratories (Abbott Park, IL), Epitope Diagnostics, Inc. (San Diego, CA), Euroimmun (Lubeck, Germany), and Ortho-Clinical Diagnostics (Rochester, NY), using a panel of serially collected serum samples (n = 224) from 56 patients with confirmed coronavirus disease 2019 (COVID-19), healthy donor sera from 2018, and a cross-reactivity serum panel collected in early 2020. The sensitivities of the Abbott, Epitope, Euroimmun, and Ortho-Clinical IgG assays in convalescent-phase serum samples collected more than 14 days post-symptom onset or post-initial positive reverse transcriptase PCR (RT-PCR) result were 92.9% (78/84), 88.1% (74/84), 97.6% (82/84), and 98.8% (83/84), respectively. Among unique convalescent patients, sensitivities of the Abbott, Epitope, Euroimmun, and Ortho-Clinical anti-SARS-CoV-2 IgG assays were 97.3% (36/37), 73% (27/37), 94.6% (35/37), and 97.3% (36/37), respectively. Overall assay specificity/positive predictive values based on a 5% prevalence rate were 99.6%/92.8%, 99.6%/90.6%, 98.0%/71.2%, and 99.6%/92.5%, respectively, for the Abbott, Epitope, Euroimmun, and Ortho-Clinical IgG assays. In conclusion, we show high sensitivity in convalescent-phase sera and high specificity for the Abbott, Euroimmun, and Ortho-Clinical anti-SARS-CoV-2 IgG assays. With the unprecedented influx of commercially available serologic tests for detection of antibodies against SARS-CoV-2, it remains imperative that laboratories thoroughly evaluate such assays for accuracy prior to implementation.

D-Dimers, Thrombin Antithrombin III Complexes and Prothrombin Fragments 1 + 2: Diagnostic value in Clinically Suspected Deep Vein Thrombosis

1991 ◽  
Vol 65 (01) ◽  
pp. 028-032 ◽  
Author(s):  
B Boneu ◽  
G Bes ◽  
H Pelzer ◽  
P Sié ◽  
H Boccalon
Keyword(s):  
Deep Vein Thrombosis ◽  
Antithrombin Iii ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Predictive Values ◽  
Vein Thrombosis ◽  
High Negative Predictive Value ◽  
Deep Vein ◽  
D Dimer ◽  
Mercury Strain Gauge

SummaryThis study was performed to determine the accuracy of D-Dimer fibrin derivatives, thrombin-antithrombin III (TAT) complexes and prothrombin fragments 1 + 2 (F 1 + 2) determinations for the diagnosis of deep vein thrombosis (DVT). One hundred and sixteen consecutive patients referred to the angiology unit of our hospital for a clinically suspected DVT were investigated. They were submitted to mercury strain gauge plethysmography and to ultrasonic duplex scanning examination; in cases of inconclusive results or of proximal DVT (n = 35), an ascending phlebography was performed. After these investigations were completed, the diagnosis of DVT was confirmed in 34 and excluded in 82. One half of the patients were already under anticoagulant therapy at the time of investigation. The 3 biological markers were assayed using commercially available ELISA techniques and the D-Dimer was also assayed with a fast latex method. The normal distribution of these markers was established in 40 healthy blood donors. The most accurate assay for the diagnosis of DVT was the D-Dimer ELISA which had both a high sensitivity (94%) and a high negative predictive value (95%). The D-Dirner latex, TAT complexes and F 1 + 2 were far less sensitive and provided negative predictive values which ranged between 78 and 85%. In spite of positive and significant correlations between the levels of ihe 3 markers, their association did not improve their overall accuracy for detecting D\/L Therefore, with the exception of the D-Dimer ELISA, these markers were of little value for the diagnosis of DVT in this specific population.

P1583UTILITY OF THE GLOBAL LEADERSHIP INITIATIVE ON MALNUTRITION CRITERIA FOR THE DETECTION OF MALNUTRITION AND DECLINE IN PHYSICAL FUNCTION AND ADL IN JAPANESE AMBULATORY HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Haruka Ito ◽  
Shohei Yamamoto ◽  
Manae Harada ◽  
Takaaki Watanabe ◽  
Yuta Suzuki ◽  
...  
Keyword(s):  
Physical Function ◽  
Phase Angle ◽  
Handgrip Strength ◽  
Hemodialysis Patients ◽  
Global Leadership ◽  
Analysis Of Covariance ◽  
Nutritional Risk ◽  
Calf Circumference ◽  
Risk Of Death ◽  
Cumulative Score

Abstract Background and Aims In patients who undergo hemodialysis (HD), malnutrition is a frequent complication associated with higher risk of death, extended hospital stay, physical limitation, and decline of activities of daily living (ADL). Therefore, proper assessment for malnutrition in this population is important for effective disease management. The Global Leadership Initiative on Malnutrition (GLIM) released new criteria for diagnosing and grading malnutrition. Nevertheless, only very few studies have investigated malnutrition prevalence on the basis of the GLIM criteria in hemodialysis patients. Hence, the usefulness of the GLIM criteria’s application in hemodialysis patients remains unclear. The aims of this study were (1) to examine whether malnutrition diagnosed on the basis of the GLIM criteria will produce equivalent results with that diagnosed with the use of existing nutritional indicators and (2) to evaluate the association between the GLIM criteria and decline of physical function and ADL in Japanese patients on HD. Method This cross-sectional study included a total of 185 outpatients who undergo HD three times a week. We measured the existing nutritional indicators (GNRI, MNA-SF, phase angle, mid-arm muscle circumference, and calf circumference), physical function (Fried Scale, handgrip strength, usual gait speed, Short Physical Performance Battery, and physical activity), and ADL status (cumulative score of Barthel Index and instrumental ADL). On the basis of the GLIM criteria, the patients were classified into two groups (no malnutrition and malnutrition). In addition, in case of nutritional risk, nutritional assessment was performed by evaluation of the phenotypic (unintentional weight loss, low BMI, and/or reduced muscle mass) and etiologic (reduced intake or assimilation and/or inflammatory response) factors. Malnutrition was diagnosed if a patient has one or more of these items. The analysis of covariance (ANCOVA) was performed to examine the association between the GLIM criteria and existing nutritional indicators, physical function, and ADL status. Results Malnutrition was diagnosed in 41.1% of the participants based on the GLIM criteria. In contrast, on the basis of the existing nutritional indicators (GNRI, MNA-SF, phase angle, mid-arm muscle circumference, and calf circumference), malnutrition was diagnosed in 22.2%, 58.3%, 48.6%, 57.9%, and 54.6%, respectively. The ANCOVA results, adjusted for the patient’s characteristics, revealed that the malnutrition group had significantly lower score than the non-malnutrition group in the existing nutritional indicators (all P < 0.001) (Figure). Furthermore, the malnutrition group had significantly higher Fried Scale scores, lower handgrip strength results, and lower ADL status than the non-malnutrition group, even after potential confounder adjustment (all P < 0.05). Conclusion The GLIM criteria could be one of the useful tools for screening the risk of malnutrition, frailty, lower handgrip strength, and lower ADL status in patients who undergo HD.

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