122 Comparing the External Validity of Clinical Prediction Tools Incorporating Serum Procalcitonin to Identify Febrile Infants (0-90 days) at Low Risk for Serious Bacterial Infection: A Retrospective Analysis

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e88-e88
Author(s):  
Chris Harper ◽  
Marie-Noelle Trottier-Boucher ◽  
Michael Chen
Keyword(s):  
Clinical Practice ◽  
Bacterial Infection ◽  
Predictive Value ◽  
Small Sample Size ◽  
Clinical Decision ◽  
Small Sample ◽  
Practice Change ◽  
Low Risk ◽  
Research Network ◽  
Decision Tools

Abstract Primary Subject area Hospital Paediatrics Background Procalcitonin (PCT), a serum inflammatory biomarker, has recently been incorporated into several clinical decision tools to identify febrile infants at low risk for serious bacterial infection (SBI). These include the Pediatric Emergency Care Applied Research Network (PECARN) tool, the “Step-by-Step” approach, and the “Laboratory-Score.” Our institution is one of a few in Canada to incorporate serum PCT routinely, allowing us to complete these clinical decision tools. Thus, the objectives of this study were to externally validate and compare these tools in a Canadian pediatric population, indirectly assessing the utility of serum PCT in clinical practice. Objectives The primary outcomes were to derive the sensitivity, specificity, and negative predictive value (NPV) of each stratification tool in predicting SBI. Design/Methods We retrospectively reviewed the medical records of all infants less than 90 days of age presenting to our emergency departments between April 2016 and October 2019 with fever without a source, who had sufficient investigations to apply one (or more) of the above clinical decision tools. Results We applied the PECARN tool to 51 cases, and had sufficient data to apply the Step-by-Step and Lab Score criteria to 43 of these patients. Seventeen of the 51 patients (33%) were identified to have a SBI. The PECARN and Step-by-Step tools both had NPV of 100%; both were sensitive enough to detect all patients with SBI. They had poor specificity (0.47 and 0.55 respectively). These two tools were in agreement in 38 of 43 (88%) cases. Though the Laboratory-Score had the highest positive predictive value (0.88) and specificity (0.85), it failed to identify 3 of 16 true cases of SBI and had a suboptimal sensitivity of 0.81. Conclusion The ability to identify febrile infants at low risk for SBI in a reliable way would have significant clinical potential to change practice. Given the strong NPV of both the PECARN and Step-by-Step tools, we conclude that their use, incorporating the measurement of serum PCT, may be of use in reducing pediatric hospitalization, use of empiric broad-spectrum antibiotics, and investigations such as lumbar punctures, in these low-risk patients. This study had a small sample size. We look forward to analyzing a larger population of febrile infants, particularly in infants of a chronologic age (28-90 days) more amenable to clinical practice change.

Focal Seizures in Patients With SCN1A Mutations

2016 ◽  
Vol 32 (2) ◽  
pp. 170-176 ◽  
Author(s):  
Christopher L. McDonald ◽  
Russell P. Saneto ◽  
Lionel Carmant ◽  
Márcio A. Sotero de Menezes
Keyword(s):  
Clinical Practice ◽  
Time Course ◽  
Pediatric Patients ◽  
Small Sample Size ◽  
Genetic Mutation ◽  
Small Sample ◽  
Focal Seizures ◽  
Clinical Considerations ◽  
New Research ◽  
Scn1a Gene

The SCN1A gene has been implicated in the etiology of various forms of epilepsy. New research has linked this gene to specific types of epilepsy, all of which present in infancy or early childhood. This study examines the time course and pathology of pediatric patients who have a mutation in the SCN1A gene in order to open a discussion regarding the key trends of this form of epilepsy as well as important clinical considerations in management for patients who present with symptoms relating to the SCN1A mutations. We retrospectively examined 20 patients who presented to the clinic with focal seizures, as well as were positive for an SCN1A genetic mutation. Despite the small sample size, we were able to find important trends in the time course of the disorder as well as important areas of clinical practice that must be taken into consideration for these patients.

The Debt Burden of Entry-Level Physical Therapists

2019 ◽  
Vol 100 (4) ◽  
pp. 591-599 ◽  
Author(s):  
Steven B Ambler
Keyword(s):  
Clinical Practice ◽  
Physical Therapy ◽  
Physical Therapists ◽  
Small Sample Size ◽  
Small Sample ◽  
Student Debt ◽  
Practice Setting ◽  
Entry Level ◽  
Debt Burden ◽  
Educational Debt

Abstract Background The growing student debt of physical therapists entering the workforce, coupled with the growth in projected need, raises concerns about where and how entry-level physical therapists will practice and if these choices will be affected by their debt burden. Objective The purpose of this study was to identify the debt profile of entry-level physical therapists and explore relationships between student debt and clinical practice setting choices. Methods This study utilized a cross-sectional survey design to identify debt profiles and explore relationships between student debt and the clinical practice choices of entry-level physical therapists. Results The mean debt-to-income ratio based on the total reported educational debt was 197% (93%). The most frequently reported debt range for doctor of physical therapy (DPT) debt and total educational debt was $100,000 to $124,999. Despite the setting itself being rated as the most important factor (83%), 28% of participants reported debt as a barrier to their desired practice setting. In addition, when considering job choice overall, 57% of the participants reported that their student debt has had an effect on their decision. Limitations This study is limited by its small sample size, originating from 1 state, and being taken by convenience from a special interest group. Data were collected via an anonymous survey, which increases the risk of selection bias. In addition, there are further personal, family, and institutional characteristics that were not collected in this study, which may influence the interaction between student debt and clinical practice choices. Conclusion The results of this study suggest that practice setting choice may be affected by physical therapist student debt, and student debt may be a barrier overall to practice and career choices in physical therapy.

Abstract TP277: Stroke Related Limb Weakness Confers Thrombotic Complications With PICC Lines

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Mohammad Ibrahim ◽  
Ravjot Sodhi ◽  
Aaron Nizam ◽  
Nabiha Khakoo ◽  
Siddhart Mehta ◽  
...  
Keyword(s):  
Predictive Value ◽  
Small Sample Size ◽  
Subsequent Development ◽  
Small Sample ◽  
Stroke Patients ◽  
Dvt Prophylaxis ◽  
Line Placement ◽  
Line Insertion ◽  
Increased Risk ◽  
Picc Line

Introduction: A peripherally inserted central catheter (PICC line) is a form of intravenous access that can be used for a prolonged period, which lowers the rate of infection. Our study aims to prove that PICC line insertion predicts a higher rate of Deep Vein Thrombosis (DVT), especially in those receiving the PICC line in a weaker arm. Methods: We conducted a retrospective analysis of stroke patients admitted to NeuroICU between September 2010 and October 2011 at a community teaching hospital. Patient records were evaluated for PICC line placement, DVT, Pulmonary Embolism (PE) development, and anticoagulant status. Odds ratios were calculated for the development of DVT and PE for PICC patients, as well as the outcomes for PICC line patients based on arm strength as defined with motor strength scale using SPSS software version 20. Results: The study included a total of 307 patients (mean age = 62.5 +/- 17.2, 51% female). Ninety-nine patients had a PICC line inserted, 22 of which developed DVT, including 10 patients who appeared to have PICC Line Related Large Venous Thrombosis. The presence of a PICC line conferred an increased risk (OR= 5.18, 95% CI, 2.40-11.2) for the development of a DVT. Patients who had a PICC line placed in a weaker arm (mean strength = 2.17) were more likely to develop a DVT than patients with a PICC line in a stronger arm (mean strength = 3.07) p<0.05. Patients given DVT prophylaxis were less likely to develop a DVT (OR = 0.32, 95% CI, .004 - .252) p < 0.05. Twenty-one patients had a CT chest angiogram performed, including six patients who had evidence of a PE. Of these six patients, one patient had a PICC line placement with subsequent development of DVT followed by PE. PICC line placement and DVT had no predictive value on the development of PE due to the small sample size. Conclusions: Our data suggests that patients who had a PICC line placed into a weaker strength arm had an increased risk of DVT in the same arm and that DVT prophylaxis significantly decreases this risk. Further studies should evaluate the predictive value of PICC line insertion with the risk of developing PE in stroke patients.

Telephone follow-up for cataract surgery: feasibility and patient satisfaction study

2016 ◽  
Vol 29 (4) ◽  
pp. 407-416 ◽  
Author(s):  
Jeremy J.S.L. Hoffman ◽  
Lucia Pelosini
Keyword(s):  
Patient Satisfaction ◽  
Cataract Surgery ◽  
Small Sample Size ◽  
Small Sample ◽  
Low Risk ◽  
Control Group ◽  
Content Type ◽  
Randomised Study ◽  
Risk Patients

Purpose – The purpose of this paper is to investigate the feasibility of telephone follow-up (TFU) after uncomplicated cataract surgery in low-risk patients and patient satisfaction with this alternative clinical pathway. Design/methodology/approach – Prospective, non-randomised cohort study. A ten-point subjective ophthalmic assessment questionnaire and a six-point patient satisfaction questionnaire were administered to patients following routine cataract surgery at two to three weeks post-procedure. All patients were offered a further clinic review if required. Exclusion criteria comprised ophthalmic co-morbidities, hearing/language impairment and high risk of post-operative complications. Patient notes were retrospectively reviewed over the study period to ensure no additional emergency attendances took place. Findings – Over three months, 50 eyes of 50 patients (mean age: 80; age range 60-91; 66 per cent second eye surgery) underwent uncomplicated phacoemulsification surgery received a TFU at 12-24 days (mean: 16 days) post-operatively. Subjective visual acuity was graded as good by 92 per cent of patients; 72 per cent patients reported no pain and 20 per cent reported mild occasional grittiness. Patient satisfaction was graded 8.9 out of 10; 81.6 per cent defined TFU as convenient and 75.5 per cent of patients preferred TFU to routine outpatient review. No additional visits were required. Research limitations/implications – Non-randomised with no control group; small sample size. One patient was unable to be contacted. Practical implications – Post-operative TFU can be suitably targeted to low-risk patients following uncomplicated cataract surgery. This study demonstrated a high patient satisfaction. A larger, randomised study is in progress to assess this further. Originality/value – This is the first study reporting TFU results and patient satisfaction to the usual alternative two-week outpatient review.

Assessing the Reliability and Use of the Expository Scoring Scheme as a Measure of Developmental Change in Monolingual English and Bilingual French/English Children

2016 ◽  
Vol 47 (4) ◽  
pp. 297-312 ◽  
Author(s):  
Elizabeth Kay-Raining Bird ◽  
Nila Joshi ◽  
Patricia L. Cleave
Keyword(s):  
Clinical Practice ◽  
Elementary School Children ◽  
Developmental Change ◽  
Small Sample Size ◽  
Age Groups ◽  
Small Sample ◽  
Intrarater Reliability ◽  
Spoken Discourse ◽  
Language Groups ◽  
Expository Discourse

Purpose The Expository Scoring Scheme (ESS) is designed to analyze the macrostructure of descriptions of a favorite game or sport. This pilot study examined inter- and intrarater reliability of the ESS and use of the scale to capture developmental change in elementary school children. Method Twenty-four children in 2 language groups (monolingual English and bilingual French/English) and 2 age groups (7–8 years, 11–12 years) participated (6 in each subgroup). Participants orally explained how to play their favorite game or sport in English. Expository discourse samples were rated for 10 macrostructure components using the ESS. Ratings were summed for a total score. Results Inter- and intrarater reliability was high for the total ESS score and for some but not all ESS components. In addition, the total score and ratings for many ESS components increased with age. Few differences were found in use of macrostructure components across language groups. Conclusions The ESS captures developmental change in the use of expository macrostructure in spoken discourse samples. It may be beneficial to take into account the lower reliability found for ratings of some ESS components in clinical practice. Due to the small sample size, these results should be considered preliminary and interpreted with caution.

scholarly journals Attitudes towards CBT in trainee clinical psychologists

2020 ◽  
Vol 15 (5) ◽  
pp. 275-286
Author(s):  
Laura Jane Hancox ◽  
David M. Gresswell ◽  
Danielle De Boos
Keyword(s):  
Clinical Practice ◽  
Small Sample Size ◽  
Behavioural Therapy ◽  
Influential Factors ◽  
Small Sample ◽  
Clinical Psychologists ◽  
Mixed Effect ◽  
Content Type ◽  
Individual Level ◽  
Significant Positive Change

Purpose This paper aims to address how one Doctorate in Clinical Psychology (DClinPsy) programme contributes to the shaping of attitudes of its trainee clinical psychologists (TCPs) towards cognitive behavioural therapy (CBT). Design/methodology/approach A total of 28 TCPs completed an online, mixed-methods questionnaire relating to their attitudes towards CBT, what factors had influenced their attitude and how competent they felt in applying CBT to clinical practice. Findings The majority of respondents reported a positive attitude towards CBT. There was a statistically significant positive change at an individual level in TCPs’ views of CBT between the point at which they applied for the DClinPsy and the present day. Thematic analysis of qualitative data identified influential factors on the development of TCP attitudes towards CBT. The vast majority of TCPs reported that they felt competent applying CBT in their clinical practice. Research limitations/implications Overall, the DClinPsy has a positive effect on TCPs’ attitudes towards CBT. However, the influence of placements has a more mixed effect on attitudes. A small sample size reduced the reliability of these conclusions. Recommendations for further evaluation have been made. Originality/value This paper evaluates the effect of a DClinPsy programme on TCPs’ attitudes towards CBT. The value is that it establishes which components of the course have different effects on trainee attitudes.

Accuracy of PECARN rule for predicting serious bacterial infection in infants with fever without a source

2020 ◽  
pp. archdischild-2020-318882 ◽  
Author(s):  
Roberto Velasco ◽  
Borja Gomez ◽  
Javier Benito ◽  
Santiago Mintegi
Keyword(s):  
Bacterial Infection ◽  
Secondary Analysis ◽  
Area Under The Curve ◽  
Prediction Rule ◽  
Low Risk ◽  
Research Network ◽  
Young Infants ◽  
Tertiary Teaching ◽  
History Of ◽  
Clinical Rule

ObjectiveTo validate the Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rule on an independent cohort of infants with fever without a source (FWS).DesignSecondary analysis of a prospective registry.SettingPaediatric emergency department of a tertiary teaching hospital.PatientsInfants ≤60 days old with FWS between 2007 and 2018.Main outcome measuresPrevalence of serious bacterial infection (SBI) and invasive bacterial infection (IBI) in low-risk infants according to the PECARN rule.ResultsAmong the 1247 infants included, 256 were diagnosed with an SBI (20.5%), including 38 IBIs (3.1%). Overall, 576 infants (46.0%; 95% CI 43.4% to 49.0%) would have been classified as low risk of SBI by the PECARN rule. Of them, 26 had an SBI (4.5%), including 5 with an IBI (2 (0.8%) diagnosed with bacterial meningitis). Sensitivity and specificity of the PECARN rule were 89.8% (95% CI 85.5% to 93.0%) and 55.5% (95% CI 52.4% to 58.6%) for SBI, with an area under the curve of 0.726 (95% CI 0.702 to 0.750). Its sensitivity to identify SBIs was 88.6% (95% CI 82.0% to 92.9%) among infants with a <6-hour history of fever (54.9% of the infants included).ConclusionsThe PECARN clinical rule for identifying SBI performed less well in our population than in the original study. This clinical rule should be applied cautiously in young infants with a short history of fever.

scholarly journals P140 As we move to using short-acting drugs for the treatment of RA in the time of a pandemic, does baricitinib live up to its trial data in clinical practice?

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Henry J S Vardon ◽  
Karen M J Douglas
Keyword(s):  
Clinical Practice ◽  
Tyrosine Kinases ◽  
Disease Duration ◽  
Small Sample Size ◽  
Small Sample ◽  
Real World Data ◽  
Short Acting ◽  
Serious Infections ◽  
Significant Difference

Abstract Background/Aims  Baricitinib is an oral, reversible and selective inhibitor of JAK1 and JAK2 tyrosine kinases. It was approved for use in 2017 by NICE for the treatment of moderate to severe rheumatoid arthritis (RA). Considering the current risk of COVID-19, the BSR have advocated the use of short-acting drugs such as baricitinib when escalating treatment in RA. As real-world data is limited, we aimed to explore the efficacy of baricitinib in clinical practice. Methods  Observational data was collected retrospectively for patients at the Dudley Group NHSFT with RA (ACR/EULAR criteria) who had received at least one dose of baricitinib prior to 1st October 2019, with a follow up period to 1st October 2020. Patients were identified from a local biologics database. Further data was identified from patients’ medical records including, demographics, features of RA, previous RA therapy history and disease activity scores (DAS28) at 0, 6 and 12 months. Data was input into an Excel spreadsheet with subsequent analysis conducted using SPSS Version26. Results  We identified 26 RA patients (77% female) treated with baricitinib; mean age 61.6 (SD 14.6) years and median disease duration of 12.1 (IQR 5.8-18.4) years. Rheumatoid factor and anti-CCP antibody were positive in 73% and 65% respectively. 35% (n = 9) of patients were biologically naïve, in whom baricitinib was chosen due to needle-phobia (n = 7), or where anti-TNF drugs were considered inappropriate (bronchiectasis, ANA positivity). Mean DAS28 (SD) scores at baseline, 6 and 12 months were 5.9(0.8), 2.8(0.9) and 2.7(1.3) respectively, with significant reduction from baseline to both 6 and 12 months (P &lt; 0.001). A drop of ≥ 1.2 in DAS28 was recorded in 94% of patients with complete data at 6 months (n = 18, 4 missing, 4 discontinued). At 6 and 12 months, 85% and 81% of patients remained on Baricitinib. In total five patients discontinued Baricitinib due to side effects or tolerability issues. Reasons for discontinuation did not include thromboembolic events, zoster or serious infections. When comparing naïve and non-naïve groups, there was no significant difference in age, sex or disease duration. The number of previous biologics used by patients were 1(n = 6), 2(n = 3), ≥3(n = 8). Biologically naive compared to non-naïve patients had a higher DAS28 at baseline, (Mean [SD]) (6.2[0.9] versus 5.7[0.8] NS) but lower at 6 months (2.1[1.6] versus 3.1[1.1] P = 0.023) and greater DAS improvement at 6months (-4.4[1.2] versus -2.5[0.9] P &lt; 0.002). Conclusion  We observed that up to 94% of patients responded to baricitinib with a mean DAS improvement at 6 months of -3.1, biologic naïve patients doing best. Drug survival at 12 months was 81%. These trends are comparable to findings in clinical trials. However, due to our small sample size, the findings are vulnerable to type 1 and 2 errors and should be interpreted with caution. Disclosure  H.J.S. Vardon: None. K.M.J. Douglas: None.

Febrile young infants with abnormal urine dipstick at low risk of invasive bacterial infection

2020 ◽  
pp. archdischild-2020-320468
Author(s):  
Roberto Velasco ◽  
Ainara Lejarzegi ◽  
Borja Gomez ◽  
Mercedes de la Torre ◽  
Isabel Duran ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Bacterial Infections ◽  
Clinical Decision Making ◽  
Prediction Rule ◽  
Clinical Decision ◽  
Low Risk ◽  
Urine Dipstick ◽  
Young Infants ◽  
Validation Set

ObjectivesTo develop and validate a prediction rule to identify well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick at low risk of invasive bacterial infections (IBIs, bacteraemia or bacterial meningitis).DesignAmbispective, multicentre study.SettingThe derivation set in a single paediatric emergency department (ED) between 2003 and 2017. The validation set in 21 European EDs between December 2017 and November 2019.PatientsTwo sets of well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick (either leucocyte esterase and/or nitrite positive test).Main outcomePrevalence of IBI in low-risk infants according to the RISeuP score.ResultsWe included 662 infants in the derivation set (IBI rate:5.2%). After logistic regression, we developed a score (RISeuP score) including age (≤15 days old), serum procalcitonin (≥0.6 ng/mL) and C reactive protein (≥20 mg/L) as risk factors. The absence of any risk factor had a sensitivity of 96.0% (95% CI 80.5% to 99.3%), a negative predictive value of 99.4% (95% CI 96.4% to 99.9%) and a specificity of 32.9% (95% CI 28.8% to 37.3%) for ruling out an IBI. Applying it in the 449 infants of the validation set (IBI rate 4.9%), sensitivity, negative predictive value and specificity were 100% (95% CI 87.1% to 100%), 100% (95% CI 97.3% to 100%) and 29.7% (95% CI 25.8% to 33.8%), respectively.ConclusionThis prediction rule accurately identified well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick at low risk of IBI. This score can be used to guide initial clinical decision-making in these patients, selecting infants suitable for an outpatient management.

scholarly journals Core psychiatry trainees views on MRCPsych course structure and delivery at East Midlands Deanery

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S141-S142
Author(s):  
Asma Javed ◽  
Hetal Acharya ◽  
Ian Yanson
Keyword(s):  
Clinical Practice ◽  
Small Sample Size ◽  
Small Sample ◽  
Teaching Programme ◽  
Course Structure ◽  
Face To Face ◽  
East Midlands ◽  
Technical Issues ◽  
Level Of Training ◽  
Full Day

AimsThe RCPsych curriculum for core training in Psychiatry (2013) requires each Deanery to run regional MRCPsych teaching programme.The East Midlands School of Psychiatry run a local MRCPsych course aimed at all core psychiatry trainees in the deanery. Before the pandemic, the course took place between two venues – Nottingham and Leicester. During the pandemic, the course was delivered via Microsoft teams. We aimed to collect the feedback from trainees regarding the course to help shape the MRCPsych Course programme according to their training needs.MethodWe devised an online Microsoft forms questionnaire which included:Level of trainingNumber of exams passedRelevance of MRCPsych content to clinical practice and membership examUsefulness of mock exams, simulation scenarios and workshops towards clinical and exam practiceOverall experience of the courseWhich additional sessions they would like to be includedThe effect of COVID-19 on their ability to attend in MRCPsych programmeThese forms were sent to all the trainees in the region via email.ResultOut of 44 trainees, 9 responded. 66.6% of the trainees who responded were CT1 and 33.3% CT2. 45% had passed Paper A and 55% had not passed any exams. 78% of them agreed and 11% strongly agreed that course was relevant to the clinical practice. 55.6% agreed that course was relevant to membership course. 44.4% agreed and 11% strongly agreed that mock exams were useful. 66.7% agreed and 11% strongly agreed that simulation case scenarios and workshops were useful for exam and clinical practice. 22.2% strongly agreed and 33.3% agreed that sessions were engaging and motivating. Overall experience of MRCPsych exam was rated as excellent (11%), good (55%), satisfactory (22%) and poor (11%).Suggestions to add additional sessions included antiracism in psychiatry, more mock exams, practical management of cases, to organise more interactive sessions on Microsoft teams, in-depth coverage of exam topics, to organise full day teaching sessions instead of half day.33.3% of trainees commented that COVID-19 had impacted on their ability to attend the exam as initially face to face sessions were cancelled till end of May 2020 and when started there were technical issues with the online platformConclusionConsider feedback received in modifying aspects of the MRCPsych courseTo share the results with trainers and course tutorsArrange relevant mock exam sessionsInclude the topics suggested by trainees and improve the experience of online learning by making it more interactiveLimitations: small sample size.

Sign in / Sign up

Export Citation Format

Share Document