Validation of Claims Algorithms to Identify Alzheimer’s Disease and Related Dementias

2021 ◽  
Author(s):  
Ellen P McCarthy ◽  
Chiang-Hua Chang ◽  
Nicholas Tilton ◽  
Mohammed U Kabeto ◽  
Kenneth M Langa ◽  
...  
Keyword(s):  
Test Performance ◽  
Healthcare Delivery ◽  
High Specificity ◽  
Cognitive Status ◽  
Lower Sensitivity ◽  
Billing Data ◽  
Trade Offs ◽  
Low Sensitivity ◽  
Study Participants ◽  
Retirement Study

Abstract BACKGROUND Using billing data generated through healthcare delivery to identify individuals with dementia has become important in research. To inform tradeoffs between approaches, we tested the validity of different Medicare claims-based algorithms. METHODS We included 5,784 Medicare-enrolled, Health and Retirement Study participants aged >65 years in 2012 clinically assessed for cognitive status over multiple waves and determined performance characteristics of different claims-based algorithms. RESULTS Positive predictive value (PPV) of claims ranged from 53.8-70.3% and was highest using a revised algorithm and 1-year of observation. The trade-off of greater PPV was lower sensitivity; sensitivity could be maximized using 3-years of observation. All algorithms had low sensitivity (31.3-56.8%) and high specificity (92.3-98.0%). Algorithm test performance varied by participant characteristics, including age and race. CONCLUSIONS Revised algorithms for dementia diagnosis using Medicare administrative data have reasonable accuracy for research purposes, but investigators should be cognizant of the trade-offs in accuracy among the approaches they consider.

scholarly journals The Rule of Histology in the Diagnosis of Periprosthetic Infection: Specific Granulocyte Counting Methods and New Immunohistologic Staining Techniques may Increase the Diagnostic Value

2016 ◽  
Vol 10 (1) ◽  
pp. 457-465 ◽  
Author(s):  
Friedrich Boettner ◽  
Gabriele Koehler ◽  
Alexander Wegner ◽  
Tom Schmidt-Braekling ◽  
Georg Gosheger ◽  
...  
Keyword(s):  
Periprosthetic Infection ◽  
High Specificity ◽  
Diagnostic Value ◽  
Lower Sensitivity ◽  
Specific Staining ◽  
Tissue Samples ◽  
Hip And Knee Arthroplasty ◽  
Staining Techniques ◽  
Low Sensitivity ◽  
Intraoperative Test

Objective: The current study investigates the diagnostic accuracy of the criteria described for frozen sections and whether modern leukocyte specific staining techniques including leukocyte peroxidase and Naphtol-AS-D-chloroacetate-esterase will improve the accuracy of the intra-operative histology. Method: 77 patients undergoing revision total hip and knee arthroplasty were included in this retrospective study. Patients were grouped into septic and aseptic based on intraoperative cultures. Tissue samples were analyzed utilizing the Mirra, Feldman, Lonner, Banit and Athanasou criteria. Results: An experienced pathologist had a high specificity (96%), but rather low sensitivity (57%) diagnosing infection. By using the Banit-, Mirra-, or Athanasou-criteria the sensitivity is increased to 0.90. The Feldman- and Lonner-criteria have a lower sensitivity (0.48 and 0.38), however, an increased specificity of 0.96 and 0.98, respectively. The Banit cut off has the highest accuracy (86%). MPOX and NACE staining increased the sensitivity and accuracy up to 100% and 92% respectively. Conclusion: Banit’s cut off is the most accurate histologic criteria to diagnose infection. Modern leukocyte specific staining techniques slightly improve the accuracy. The synovial fluid white blood cell count appears to be the most accurate intraoperative test.

scholarly journals Factors Impacting the Performance Characteristics of Bile Duct Brushings: A Clinico-Cytopathologic Analysis of 253 Patients

2018 ◽  
Vol 142 (7) ◽  
pp. 863-870 ◽  
Author(s):  
Ezgi Hacihasanoglu ◽  
Bahar Memis ◽  
Burcin Pehlivanoglu ◽  
Vaidehi Avadhani ◽  
Alexa A. Freedman, ◽  
...  
Keyword(s):  
Bile Duct ◽  
Predictive Value ◽  
High Specificity ◽  
Daily Practice ◽  
Performance Characteristics ◽  
Lower Sensitivity ◽  
Current State ◽  
Risk Of Malignancy ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Context.— Literature on factors impacting bile duct brushings (BDBs) performance characteristics remain limited. Objective.— To capture the current state of daily practice with BDB sign-out. Design.— Two hundred fifty-three of 444 BDBs signed out by more than 7 cytopathologists, with histopathologic and/or clinical follow-up of at least 18 months, were examined. Results.— One hundred thirty-five of 253 BDBs (53%) had histologically confirmed malignancies, 22 (9%) had cancer-related deaths, and 96 (38%) were benign. Cytologic diagnoses in the 444 BDBs were nondiagnostic (11 [2.5%]), negative (284 [64%]), atypical (62 [13.9%]), suspicious (34 [7.7%]), and malignant (53 [11.9%]). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of malignancy detection were 35%, 100%, 100%, 58%, and 66%, respectively. When atypical, suspicious, and malignant (ASM) categories were combined, sensitivity increased (58%), specificity and PPV dropped (97%), and accuracy increased (73%). Carcinoma type (bile-duct versus pancreatic-ductal) had no effect on accuracy (P = .60) or diagnostic class (P = .84), nor did time of performance (first 7.5 versus latter 7.5 years, P = .13). Interestingly, ThinPrep + cell block (n = 41) had higher sensitivity (61%) and lower specificity (80%) than ThinPrep only (versus 51% and 100%, respectively). Sensitivity and specificity were higher (47% and 100%) in nonstented than stented specimens (59% and 97%). Relative risk of malignancy for “suspicious” (2.30) and “atypical” (2.28) categories was lower but not very different from that of “malignant” category (2.41). Conclusions.— Bile duct brushings had fairly low sensitivity but high specificity and PPV with no false positives. Sensitivity almost doubled and specificity dipped minimally when ASM categories were combined, highlighting the need for better classification criteria for atypical/suspicious cases. Higher specificity, PPV, NPV, and accuracy but lower sensitivity in stented BDBs suggest that they be called malignant only when evidence is overwhelmingly convincing.

Abstract P109: Consistency of Self-reported Prior Diagnosis of Atrial Fibrillation and Medicare Claims Diagnoses: The Reasons for Geographic and Racial Differences in Stroke

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Oluseun O Akinyele ◽  
Elsayed Z Soliman ◽  
Ligong Chen ◽  
Hooman Kamel ◽  
Emily B Levitan
Keyword(s):  
Atrial Fibrillation ◽  
Health Professional ◽  
Racial Differences ◽  
High Specificity ◽  
Cognitive Status ◽  
Self Report ◽  
Fee For Service ◽  
Medicare Claims ◽  
Regards Study ◽  
Low Sensitivity

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Although self-reported prior diagnosis is a widely used method for ascertainment of AF in population studies, recall bias may impact the accuracy of this method. Objective: To examine the consistency of self-reported AF as compared to diagnoses recorded in Medicare claims. Methods: Among 30,239 black and white adults aged 45 years and older who enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, 8,588 participants aged 65 years and older with a minimum of 6 months of Medicare fee-for-service coverage at the time of enrollment were included in this analysis. Using AF diagnosis codes from Medicare claims as the “gold standard”, we calculated sensitivity, specificity, positive predictive value (PPV), and negative predicted value (NPV) of self-reported prior diagnosis of AF by a physician or other health professional. Results: The average age of the study population was 73.4 years, 50.5% were women, 31.6% were black, and 10.1% reported a prior diagnosis of AF. The prevalence of Medicare claims diagnoses for AF ranged from 28.6% to 32.5% depending on definition ( Table ). Compared to Medicare claims, self-reported prior diagnosis of AF had 22.4-24.5% sensitivity, 95.6-95.7% specificity, 68.8-71.5% PPV, and 71.9-76.0% NPV. Results were consistent across strata defined by age, gender, race, and cognitive status. Conclusion: Compared to Medicare claims, self-reported prior diagnosis by a physician or other health professional had low sensitivity but high specificity to detect AF. This suggests that an approach utilizing only self-report to detect AF would not be ideal. However, most participants who reported a prior diagnosis of AF had Medicare claims supporting this diagnosis.

scholarly journals Development of a Sensitive and Specific Serological Assay Based on Luminex Technology for Detection of Antibodies to Zaire Ebola Virus

2016 ◽  
Vol 55 (1) ◽  
pp. 165-176 ◽  
Author(s):  
Ahidjo Ayouba ◽  
Abdoulaye Touré ◽  
Christelle Butel ◽  
Alpha Kabinet Keita ◽  
Florian Binetruy ◽  
...  
Keyword(s):  
Test Performance ◽  
Ebola Virus ◽  
High Specificity ◽  
Antibody Detection ◽  
Lower Sensitivity ◽  
Serological Assay ◽  
Epidemiological Surveys ◽  
Luminex Technology ◽  
Ebov Infection ◽  
Almost All

ABSTRACT The recent Zaire Ebola virus (EBOV) outbreak in West Africa illustrates clearly the need for additional studies with humans and animals to elucidate the ecology of Ebola viruses (EBVs). In this study, we developed a serological assay based on the Luminex technology. Nine recombinant proteins representing different viral regions (nucleoprotein [NP], 40-kDa viral protein [VP40], and glycoprotein [GP]) from four of the five EBV lineages were used. Samples from 94 survivors of the EBOV outbreak in Guinea and negative samples from 108 patients in France were used to calculate test performance for EBOV detection and cross-reaction with other Ebola virus lineages. For EBOV antibody detection, sensitivities of 95.7%, 96.8%, and 92.5% and specificities of 94.4%, 95.4%, and 96.3% for NP, GP, and VP40, respectively, were observed. All EBOV-negative samples that presented a reaction, except for one, interacted with a single antigen, whereas almost all samples from EBOV survivors were simultaneously reactive with NP and GP (90/94) or with NP, GP, and VP40 (87/94). Considering as positive for past EBOV infection only samples that reacted with EBOV NP and GP, sensitivity was 95.7% and specificity increased to 99.1%. Comparing results with commercial EBOV NP and GP enzyme-linked immunosorbent assays (ELISAs; Alpha Diagnostic, San Antonio, TX), lower sensitivity (92.5%) and high specificity (100%) were observed with the same positivity criteria. Samples from EBOV survivors cross-reacted with GP from Sudan Ebola virus (GP-SUDV) (81.9%), GP from Bundibugyo Ebola virus (GP-BDBV) (51.1%), GP from Reston Ebola virus (GP-RESTV) (9.6%), VP40-SUDV (76.6%), and VP40-BDBV (38.3%). Overall, we developed a sensitive and specific high-throughput serological assay, and defined an algorithm, for epidemiological surveys with humans.

Hit and False-Alarm Rates of Selected ABR Indices in Differentiating Cochlear Disorders From Acoustic Tumors

1996 ◽  
Vol 5 (1) ◽  
pp. 90-96 ◽  
Author(s):  
Frank E. Musiek ◽  
Cynthia A. McCormick ◽  
Raymond M. Hurley
Keyword(s):  
False Alarm ◽  
Amplitude Ratio ◽  
High Specificity ◽  
Auditory Brainstem ◽  
Latency Difference ◽  
Cochlear Pathology ◽  
Brainstem Response ◽  
Absolute Latency ◽  
Two Indices ◽  
Low Sensitivity

We performed a retrospective study of 26 patients with acoustic tumors and 26 patients with otologically diagnosed cochlear pathology to determine the sensitivity (hit rate), specificity (false-alarm rate), and efficiency of six auditory brainstem response indices. In addition, a utility value was determined for each of these six indices. The I–V interwave interval, the interaural latency difference, and the absolute latency of wave V provided the highest hit rates, the best A’ values and good utility. The V/I amplitude ratio index provided high specificity but low sensitivity scores. In regard to sensitivity and specificity, using the combination of two indices provided little overall improvement over the best one-index measures.

scholarly journals A Longitudinal Study of Retirement Transition and Advance Directive Completion

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 441-441
Author(s):  
Catheryn Koss
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
Multinomial Logistic Regression ◽  
Statistical Significance ◽  
Optimal Time ◽  
Retirement Transition ◽  
Multistep Process ◽  
Study Participants ◽  
Retirement Study

Abstract Advance directives (AD) help to ensure patients’ wishes are honored and contribute to improved end-of-life care. According to normative life course theory, retirement is a significant role change that signals a transition into the third age and its socially prescribed activities. To the extent that ACP is viewed as something to do when one reaches a more advanced stage in life, retirement may spark recognition that planning for incapacity and the end of life is now personally relevant and appropriate. This study tested whether transitioning from work to retirement prompted AD completion. The sample included Health and Retirement Study participants 65 and older who, in 2012, had no ADs and were not completely retired (N = 919). Retirement was operationalized as both a categorical status and as a multistep process. Three waves of data were analyzed using multinomial logistic regression to test associations between retirement transition and advance directive completion. By 2014, 21% had completed ADs and another 17% completed them by 2016. Those who completely retired between 2012 and 2014 were almost twice as likely to complete ADs between 2014 and 2016. Graduated increase in level of retirement between 2012 and 2014 was associated with higher odds of new AD possession in 2016, but did not reach statistical significance at p < .05. These results suggest the period following retirement may be an optimal time to encourage patients and clients who have not already done so to complete advance directives.

Validity of hearTest Smartphone-Based Audiometry for Hearing Screening in Workers Exposed to Noise

2020 ◽  
Author(s):  
Luma Cordeiro Rodrigues ◽  
Silvia Ferrite ◽  
Ana Paula Corona
Keyword(s):  
Hearing Loss ◽  
High Specificity ◽  
Hearing Screening ◽  
Youden Index ◽  
Hearing Level ◽  
Predictive Values ◽  
Auditory Thresholds ◽  
The Mean ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Abstract Purpose This article investigates the validity of a smartphone-based audiometry for hearing screening to identify hearing loss in workers exposed to noise. Research Design This is a validation study comparing hearing screening with the hearTest to conventional audiometry. The study population included all workers who attended the Brazilian Social Service of Industry to undergo periodic examinations. Sensitivity, specificity, the Youden index, and positive (PPV) and negative predictive values (NPV) for hearing screening obtained by the hearTest were estimated according to three definitions of hearing loss: any threshold greater than 25 dB hearing level (HL), the mean auditory thresholds for 0.5, 1, 2, and 4 kHz greater than 25 dB HL, and the mean thresholds for 3, 4, and 6 kHz greater than 25 dB HL. Note that 95% confidence intervals were calculated for all measurements. Results A total of 232 workers participated in the study. Hearing screening with the hearTest presented good sensitivity (93.8%), specificity (83.9%), and Youden index (77.7%) values, a NPV (97.2%), and a low PPV (69.0%) for the identification of hearing loss defined as any auditory threshold greater than 25 dB HL. For the other definitions of hearing loss, we observed high specificity, PPV and NPV, as well as low sensitivity and Youden index. Conclusion The hearTest is an accurate hearing screening tool to identify hearing loss in workers exposed to noise, including those with noise-induced hearing loss, although it does not replace conventional audiometry.

scholarly journals Age Differences in Executive Control Assessed with a Robotic Object Hit and Avoid Test of Rapid Motor Decision Making

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 881-882
Author(s):  
Alexandra Watral ◽  
Kevin Trewartha
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Executive Functioning ◽  
Age Differences ◽  
Executive Control ◽  
Test Performance ◽  
Cognitive Status ◽  
Younger Adults ◽  
Neuropsychological Tasks ◽  
Measures Of Performance

Abstract Motor decision-making processes are required for many standard neuropsychological tasks, including the Trail Making Test (TMT), that aim to assess cognitive functioning in older adults. However, in their standard formats, it is difficult to isolate the relative contributions of sensorimotor and cognitive processes to performance on these neuropsychological tasks. Recently developed clinical tasks use a robotic manipulandum to assess both motor and cognitive aspects of rapid motor decision making in an object hit (OH) and object hit and avoid (OHA) task. We administered the OH and OHA tasks to 77 healthy younger adults and 59 healthy older adults to assess age differences in the motor and cognitive measures of performance. We administered the TMT parts A and B to assess the extent to which OHA performance is associated with executive functioning in particular. The results indicate that after controlling for hand speed, older adults performed worse on the OH and OHA tasks than younger adults, performance declines were far greater in the OHA task, and the global performance measures, which have been associated with cognitive status, were more sensitive to age differences than motor measures of performance. Those global measures of performance were also associated with measures of executive functioning on the TMT task. These findings provide evidence that rapid motor decision making tasks are sensitive to declines in executive control in aging. They also provide a way to isolate cognitive declines from declines in sensorimotor processes that are likely a contributing factor to age differences in neuropsychological test performance.

scholarly journals Same-Sex Couples and Cognitive Impairment: Evidence From the Health and Retirement Study

2020 ◽  
Author(s):  
Hui Liu ◽  
Ning Hsieh ◽  
Zhenmei Zhang ◽  
Yan Zhang ◽  
Kenneth M Langa
Keyword(s):  
Cognitive Impairment ◽  
The United States ◽  
Population Based ◽  
Cognitive Status ◽  
Health And Retirement Study ◽  
Sex Partners ◽  
Physical And Mental Health ◽  
Same Sex ◽  
Same Sex Couples ◽  
Retirement Study

Abstract Objectives We provide the first nationally representative population-based study of cognitive disparities among same-sex and different-sex couples in the United States. Methods We analyzed data from the Health and Retirement Study (2000–2016). The sample included 23,669 respondents (196 same-sex partners and 23,473 different-sex partners) aged 50 and older who contributed to 85,117 person-period records (496 from same-sex partners and 84,621 from different-sex partners). Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status. Mixed-effects discrete-time hazard regression models were estimated to predict the odds of cognitive impairment. Results The estimated odds of cognitive impairment were 78% (p < .01) higher for same-sex partners than for different-sex partners. This disparity was mainly explained by differences in marital status and, to a much lesser extent, by differences in physical and mental health. Specifically, a significantly higher proportion of same-sex partners than different-sex partners were cohabiting rather than legally married (72.98% vs. 5.42% in the study sample), and cohabitors had a significantly higher risk of cognitive impairment than their married counterparts (odds ratio = 1.53, p < .001). Discussion The findings indicate that designing and implementing public policies and programs that work to eliminate societal homophobia, especially among older adults, is a critical step in reducing the elevated risk of cognitive impairment among older same-sex couples.

Is Endoscopic Assessment of the Esophagus and Stomach Enough to Determine the Need for Biopsy at These Sites in Pediatric Patients Undergoing Endoscopy for Elevated TTG?

2021 ◽  
pp. 109352662199148
Author(s):  
M. Cristina Pacheco ◽  
Nicole Green ◽  
Jane Dickerson ◽  
Dale Lee
Keyword(s):  
Sensitivity And Specificity ◽  
Pediatric Patients ◽  
Tissue Transglutaminase ◽  
Immunoglobulin A ◽  
High Specificity ◽  
Visual Assessment ◽  
Pathology Report ◽  
Low Sensitivity ◽  
Endoscopic Assessment

Objectives The goal of our study was to determine whether visual assessment of the esophagus and stomach could predict abnormal histology and determine the frequency of interventions based on biopsies in patients undergoing endoscopy for elevated tissue transglutaminase immunoglobulin A antibody (TTG). Methods Pathology records were searched for patients with biopsy performed for elevated TTG. Pathology report, endoscopy report, and follow-up were obtained and slides from the duodenum reviewed. Pathology was considered gold standard for sensitivity and specificity calculations. Results 240 patients were included. 215 patients had esophageal biopsies performed. Esophageal endoscopic visual assessment had sensitivity of 47% and specificity of 93% for abnormal histology. 16(7%) patients had therapy or referral related to results and, of these, 6(38%) had visually normal endoscopy. 237 biopsies were performed of stomach. Gastric endoscopic visual assessment had a sensitivity and specificity of 20% and 87%. 24(10%) patients had therapy based on findings and, of these, 12 (50%) had visually normal endoscopy. Conclusions Endoscopic assessment of esophagus and stomach has low sensitivity and high specificity for pathologic abnormalities when indication for endoscopy is elevated TTG. When endoscopy is visually normal clinical interventions based on biopsy are rare, and foregoing biopsy may be considered.

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