4971Blood viscosity and its relevance to the diagnosis and management of pulmonary hypertension: a new elephant in the cathlab

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kempny ◽  
K Dimopoulos ◽  
A E Fraisse ◽  
G P Diller ◽  
L C Price ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Catheterization ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Pulmonary Vasculature ◽  
Pulmonary Vascular Disease ◽  
Significant Difference ◽  
The Difference ◽  
Clinically Significant ◽  
The Relationship

Abstract Background Pulmonary vascular resistance (PVR) is an essential parameter assessed during cardiac catheterization. It is used to confirm pulmonary vascular disease, to assess response to targeted pulmonary hypertension (PH) therapy and to determine the possibility of surgery, such as closure of intra-cardiac shunt or transplantation. While PVR is believed to mainly reflect the properties of the pulmonary vasculature, it is also related to blood viscosity (BV). Objectives We aimed to assess the relationship between measured (mPVR) and viscosity-corrected PVR (cPVR) and its impact on clinical decision-making. Methods We assessed consecutive PH patients undergoing cardiac catheterization. BV was assessed using the Hutton method. Results We included 465 patients (56.6% female, median age 63y). The difference between mPVR and cPVR was highest in patients with abnormal Hb levels (anemic patients: 5.6 [3.4–8.0] vs 7.8Wood Units (WU) [5.1–11.9], P<0.001; patients with raised Hb: 10.8 [6.9–15.4] vs. 7.6WU [4.6–10.8], P<0.001, respectively). Overall, 33.3% patients had a clinically significant (>2.0WU) difference between mPVR and cPVR, and this was more pronounced in those with anemia (52.9%) or raised Hb (77.6%). In patients in the upper quartile for this difference, mPVR and cPVR differed by 4.0WU [3.4–5.2]. Adjustment of PVR required Conclusions We report, herewith, a clinically significant difference between mPVR and cPVR in a third of contemporary patients assessed for PH. This difference is most pronounced in patients with anemia, in whom mPVR significantly underestimates PVR, whereas in most patients with raised Hb, mPVR overestimates it. Our data suggest that routine adjustment for BV is necessary.

Samples spiked with pituitary-derived thyroid-stimulating hormone may disguise the extent of differences between thyroid-stimulating hormone assays

2021 ◽  
pp. 000456322110425
Author(s):  
Tejas Kalaria ◽  
Jonathan Fenn ◽  
Hayley Sharrod-Cole ◽  
Anna Sanders ◽  
Clare Ford ◽  
...  
Keyword(s):  
Clinical Decision ◽  
Thyroid Stimulating Hormone ◽  
Serum Samples ◽  
Serum Pool ◽  
The Difference ◽  
Clinically Significant ◽  
Relationship Of ◽  
The Relationship ◽  
Eqa Schemes ◽  
Stimulating Hormone

Background A large discordance in the diagnosis and potential management of hypothyroidism using Abbott and Roche thyroid assays has been reported recently. The difference in Abbott and Roche thyroid-stimulating hormone (TSH) results in these studies was larger than anticipated from the external quality assessment (EQA) reports. Methods Abbott and Roche TSH method means in UK NEQAS for thyroid hormones distributions 430 to 454 were compared against the amount of TSH spiked. A TSH deplete serum pool was spiked with various concentrations of pooled high TSH serum and 3rd WHO International Standard for TSH (WHO-IS). Four serum pools with TSH close to clinical decision limits were spiked with two concentrations of WHO-IS. Results On review of EQA data, median (IQR) Roche: Abbott TSH ratio was lower ( p < 0.001) in 48 pools spiked with TSH (1.11 (1.07–1.16)) compared to 41 pools not spiked (1.29 (1.25–1.31)) and the decrease was proportionate to the contribution of spiked TSH to total TSH in the samples (ρ=−0.908, p < 0.001). In spiking experiments, the relationship of Roche and Abbott TSH was different in TSH deplete pool spiked with WHO-IS (RocheTSH=1.13*AbbottTSH–0.52) and high TSH serum (RocheTSH=1.43*AbbottTSH–0.50), respectively. The Roche: Abbott TSH ratio decreased and the method agreement improved on spiking serum pools with WHO-IS. Conclusion Abbott and Roche TSH assays are not in harmony in human serum samples but the agreement was better in samples spiked with WHO-IS which contains pituitary-derived TSH. Use of pituitary-derived TSH spiked samples, such as provided by EQA schemes, may mask clinically significant between-assay differences.

scholarly journals Predicting mortality in adults with suspected infection in a Rwandan hospital: an evaluation of the adapted MEWS, qSOFA and UVA scores

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e040361
Author(s):  
Amanda Klinger ◽  
Ariel Mueller ◽  
Tori Sutherland ◽  
Christophe Mpirimbanyi ◽  
Elie Nziyomaze ◽  
...  
Keyword(s):  
Decision Making ◽  
Quality Improvement ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Tertiary Hospital ◽  
Early Warning Score ◽  
Receiver Operating Curve ◽  
Predictive Capacity ◽  
Suspected Infection ◽  
Significant Difference

RationaleMortality prediction scores are increasingly being evaluated in low and middle income countries (LMICs) for research comparisons, quality improvement and clinical decision-making. The modified early warning score (MEWS), quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and Universal Vital Assessment (UVA) score use variables that are feasible to obtain, and have demonstrated potential to predict mortality in LMIC cohorts.ObjectiveTo determine the predictive capacity of adapted MEWS, qSOFA and UVA in a Rwandan hospital.Design, setting, participants and outcome measuresWe prospectively collected data on all adult patients admitted to a tertiary hospital in Rwanda with suspected infection over 7 months. We calculated an adapted MEWS, qSOFA and UVA score for each participant. The predictive capacity of each score was assessed including sensitivity, specificity, positive and negative predictive value, OR, area under the receiver operating curve (AUROC) and performance by underlying risk quartile.ResultsWe screened 19 178 patient days, and enrolled 647 unique patients. Median age was 35 years, and in-hospital mortality was 18.1%. The proportion of data missing for each variable ranged from 0% to 11.7%. The sensitivities and specificities of the scores were: adapted MEWS >4, 50.4% and 74.9%, respectively; qSOFA >2, 24.8% and 90.4%, respectively; and UVA >4, 28.2% and 91.1%, respectively. The scores as continuous variables demonstrated the following AUROCs: adapted MEWS 0.69 (95% CI 0.64 to 0.74), qSOFA 0.65 (95% CI 0.60 to 0.70), and UVA 0.71 (95% CI 0.66 to 0.76); there was no statistically significant difference between the discriminative capacities of the scores.ConclusionThree scores demonstrated a modest ability to predict mortality in a prospective study of inpatients with suspected infection at a Rwandan tertiary hospital. Careful consideration must be given to their adequacy before using them in research comparisons, quality improvement or clinical decision-making.

scholarly journals Over one third of patients with symptomatic femoroacetabular impingement display femoral or acetabular version abnormalities

2021 ◽  
Author(s):  
Zaki Arshad ◽  
Henry David Maughan ◽  
Karadi Hari Sunil Kumar ◽  
Matthew Pettit ◽  
Arvind Arora ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Original Research ◽  
Distribution Analysis ◽  
Inclusion Criteria ◽  
Acetabular Version ◽  
Level Of Evidence ◽  
Femoral Version ◽  
Normal Mean ◽  
The Relationship

Abstract Purpose The aim of this study was investigate the relationship between version and torsional abnormalities of the acetabulum, femur and tibia in patients with symptomatic FAI. Methods A systematic review was performed according to PRISMA guidelines using the EMBASE, MEDLINE, PubMed and Cochrane databases. Original research articles evaluating the described version and torsional parameters in FAI were included. The MINORS criteria were used to appraise study quality and risk of bias. Mean version and torsion values were displayed using forest plots and the estimated proportion of hips displaying abnormalities in version/torsion were calculated. Results A total of 1206 articles were identified from the initial search, with 43 articles, involving 8861 hips, meeting the inclusion criteria. All studies evaluating femoral or acetabular version in FAI reported ‘normal’ mean version values (10–25 °). However, distribution analysis revealed that an estimated 31% and 51% of patients with FAI displayed abnormal central acetabular and femoral version, respectively. Conclusion Up to 51% of patients presenting with symptomatic FAI show an abnormal femoral version, whilst up to 31% demonstrate abnormal acetabular version. This high percentage of version abnormalities highlights the importance of evaluating these parameters routinely during assessment of patients with FAI, to guide clinical decision-making. Level of evidence IV.

Attention Deficit Hyperactivity Disorder, Creativity, and the Effects of Methylphenidate

PEDIATRICS ◽  
1993 ◽  
Vol 91 (4) ◽  
pp. 816-819
Author(s):  
Jeanne B. Funk ◽  
John B. Chessare ◽  
Michael T. Weaver ◽  
Anita R. Exley
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Repeated Measures ◽  
Creative Thinking ◽  
Adhd Group ◽  
Hyperactivity Disorder ◽  
Significant Difference ◽  
Quasi Experimental ◽  
The Difference ◽  
Clinically Significant

Given that children with attention deficit hyperactivity disorder (ADHD) are more impulsive than peers, this study explored whether they are correspondingly more creative, and whether creativity declines when impulsivity is decreased through methylphenidate (Ritalin) therapy. A repeated-measures quasi-experimental design was used to compare the performance of 19 boys with previously diagnosed ADHD and 21 comparison boys aged 8 through 11 on two administrations of alternate forms of the Torrance Tests of Creative Thinking-Figural (nonverbal). Boys with ADHD received prescribed methylphenidate only for the first session. Overall, mean Torrance summary scores for comparison boys (mean = 115.1, SD = 16.1) were higher than for boys with ADHD (mean = 107.6, SD = 12.7). However, the difference between means was small (7%) and did not meet the 25% criterion for a clinically significant difference. No changes in performance over time (comparison group) or medication state (ADHD group) were observed. These data suggest that, when measured nonverbally, the creative thinking performance of boys with ADHD is not superior to that of peers who do not have ADHD. Regarding the effects of methylphenidate, prescribed therapy did not influence performance on this measure of creative thinking.

Standardized Synoptic Cancer Pathology Reports — So What and Who Cares?: A Population-Based Satisfaction Survey of 970 Pathologists, Surgeons, and Oncologists

2013 ◽  
Vol 137 (11) ◽  
pp. 1599-1602 ◽  
Author(s):  
Sara Lankshear ◽  
John Srigley ◽  
Thomas McGowan ◽  
Marta Yurcan ◽  
Carol Sawka
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Physician Satisfaction ◽  
Cross Sectional ◽  
Cancer Pathology ◽  
Report Turnaround Time ◽  
Significant Difference ◽  
Pathology Reporting ◽  
The Impact

Context.—Cancer Care Ontario implemented synoptic pathology reporting across Ontario, impacting the practice of pathologists, surgeons, and medical and radiation oncologists. The benefits of standardized synoptic pathology reporting include enhanced completeness and improved consistency in comparison with narrative reports, with reported challenges including increased workload and report turnaround time. Objective.—To determine the impact of synoptic pathology reporting on physician satisfaction specific to practice and process. Design.—A descriptive, cross-sectional design was utilized involving 970 clinicians across 27 hospitals. An 11-item survey was developed to obtain information regarding timeliness, completeness, clarity, and usability. Open-ended questions were also employed to obtain qualitative comments. Results.—A 51% response rate was obtained, with descriptive statistics reporting that physicians perceive synoptic reports as significantly better than narrative reports. Correlation analysis revealed a moderately strong, positive relationship between respondents' perceptions of overall satisfaction with the level of information provided and perceptions of completeness for clinical decision making (r = 0.750, P &lt; .001) and ease of finding information for clinical decision making (r = 0.663, P &lt; .001). Dependent t tests showed a statistically significant difference in the satisfaction scores of pathologists and oncologists (t169 = 3.044, P = .003). Qualitative comments revealed technology-related issues as the most frequently cited factor impacting timeliness of report completion. Conclusion.—This study provides evidence of strong physician satisfaction with synoptic cancer pathology reporting as a clinical decision support tool in the diagnosis, prognosis, and treatment of cancer patients.

scholarly journals Multiple Sclerosis and Diabetes Mellitus: Further Evidence of a Relationship

1982 ◽  
Vol 9 (4) ◽  
pp. 415-419 ◽  
Author(s):  
Sharon A. Warren ◽  
K.G. Warren
Keyword(s):  
Diabetes Mellitus ◽  
Multiple Sclerosis ◽  
Healthy Controls ◽  
Degree Relative ◽  
Significant Difference ◽  
The Difference ◽  
The Relationship ◽  
Prevalence Of Diabetes Mellitus ◽  
Second Degree

SUMMARY:One hundred multiple sclerosis (MS) patients were compared to healthy controls to determine the prevalence of diabetes mellitus in their families. Significantly, more MS patients than controls were diabetic or reported at least one first degree relative (parent, sibling, child) with diabetes. The relationship between MS and diabetes persisted when second degree relatives (grandparents, aunts and uncles) were taken into consideration.A greater percentage of MS patients with another MS relative were diabetic or reported a first degree relative with diabetes mellitus than MS patients without an MS relative. However the difference was not statistically significant. Nor was there a significant difference when percentages reporting either a first or a second degree relative with diabetes were compared.

scholarly journals Migraine in Obesity: Is It Prevalent?

2020 ◽  
Vol 19 (2) ◽  
pp. 1-5
Author(s):  
Aso Sabir Saeed ◽  
◽  
Osama MohammadAmin Shukr
Keyword(s):  
Body Mass Index ◽  
Waist Circumference ◽  
P Value ◽  
Cross Sectional ◽  
Waist To Hip Ratio ◽  
Migraine Prevalence ◽  
Significant Difference ◽  
Keywords Migraine ◽  
The Difference ◽  
The Relationship

Background: Several studies have demonstrated an association between obesity and migraine. It’s still unclear whether migraine is the cause or it's the result of obesity. Objective: We investigated the prevalence of migraine among obese and non-obese individuals and analyzed the relationship between migraine prevalence and obesity. Patients and Methods: This is cross-sectional observational study was carried out at the neurology outpatients’ department of the Rizgary Teaching Hospital in Erbil, Iraq, from July 1st , 2018 to September 30, 2019. We interviewed and examined 300 persons, both obese (n=154) and non-obese (n=146), and of both gender. All of them were adults (>18 years old). Each person's weight, height, body mass index (BMI), and waist circumference were measured.The diagnosis of migraine was made according to the International Headache Society’s criteria. Obesity was present if the individual’s BMI is ≥30 and/or waist-to-hip ratio is >0.9 in females and >1.0 in males. Results: Out of the 300 persons, 14 males (8.5%) got migraines while migraine was found in 37 females (27.4%), irrespective of their weight. Out of the 300 persons, the prevalence of migraine among obese individuals was 21.4% (n=33) and while in non-obese individuals was 12.3% (n=18). There was a statistically significant difference between the groups (p-value=0.045). The overall prevalence of migraine was 16.9% of the persons interviewed. Conclusion: The results showed that migraine is more prevalent among obese persons than non-obese persons and the difference was statistically significant. Keywords: Migraine, obesity, BMI, headache

scholarly journals A Comparison Between Two Types of Radiographic Film for Accuracy of Measurements of Approximal Osseous Defects

2006 ◽  
Vol 7 (3) ◽  
pp. 22-29
Author(s):  
Farah Masood ◽  
Christos Angelopoulos ◽  
Alan Glaros
Keyword(s):  
Bone Loss ◽  
Ground Truth ◽  
Radiographic Film ◽  
Radiographic Images ◽  
Accuracy Of Measurements ◽  
Significant Difference ◽  
Molar Teeth ◽  
The Difference ◽  
Clinically Significant ◽  
Osseous Defects

Abstract Aim The purpose of this study was to compare two types of conventional radiographic film: Ekta-speed plus and Insight (Eastman Kodak Co, Rochester NY, USA) for accuracy of measurements of approximal bone loss. Methods and Materials Four dried human mandibles with complete dentition were selected. Radiographic images were made with a standardized technique. Mesial and distal bone levels on the mandibular premolar and molar teeth were measured on the two types of radiographs (Ekta-speed plus and Insight) by nine observers. The data obtained by the observers were compared with the primary investigators’ corresponding measurements, which served as “the ground truth” for this study. Results The results of the analysis of variance (ANOVA) demonstrated a significant difference for the Ektaspeed plus film (p = .001), but the difference was not clinically significant. The level of intra-rater reliability was high for the observers (0.969 to 0.990). Conclusion Performance of Ekta-speed plus and Insight films was found to be similar. Citation Masood F, Angelopoulos C, Glaros A. A Comparison Between Two Types of Radiographic Film for Accuracy of Measurements of Approximal Osseous Defects. J Contemp Dent Pract 2006 July;(7)3:022-029.

scholarly journals Pulmonary hypertension: Proteins in the blood

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
Martin Wilkins
Keyword(s):  
Pulmonary Hypertension ◽  
New Technology ◽  
Local Environment ◽  
Pulmonary Vasculature ◽  
Pulmonary Vascular Disease ◽  
Plasma Proteome ◽  
Bioinformatic Tools ◽  
Non Invasive ◽  
New Biomarkers ◽  
Small Aliquot

The plasma proteome is rich in information. It comprises proteins that are secreted or lost from cells as they respond to their local environment. Changes in the constitution of the plasma proteome offer a relatively non-invasive report on the health of tissues. This is particularly true of the lung in pulmonary hypertension, given the large surface area of the pulmonary vasculature in direct communication with blood. So far, this is relatively untapped; we have relied on proteins released from the heart, specifically brain natriuretic peptide and troponin, to inform clinical management. New technology allows the measurement of a larger number of proteins that cover a broad range of molecular pathways in a single small aliquot. The emerging data will yield more than just new biomarkers of pulmonary hypertension for clinical use. Integrated with genomics and with the help of new bioinformatic tools, the plasma proteome can provide insight into the causative drivers of pulmonary vascular disease and guide drug development.

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