scholarly journals 1188 Test Characteristics of a Machine Learned Electronic Medical Record Extractable Tool for OSA Case Identification in a Community-Based Population

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A454-A454
Author(s):  
S I Patel ◽  
D Kukafka ◽  
C Antonescu ◽  
D Combs ◽  
J Lee-Iannotti ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Oxygen Desaturation ◽  
Positive Test ◽  
Community Based ◽  
Sleep Study ◽  
Case Identification ◽  
Test Characteristics ◽  
Patient Reported

Abstract Introduction Obstructive sleep apnea (OSA) is a significantly underdiagnosed medical condition. A machine learning method known as SLIM (Supersparse Linear Integer Models) that can be extracted from the Electronic Health Record (EHR) has found to be superior to patient-reported sleep-related symptoms to diagnose OSA. Such an evaluation, however, was previously validated in a laboratory-based population. Our aim was to determine the test characteristics for the EHR-extractable SLIM tool in a community-based population. Methods Subjects who participated in the Sleep Heart Health Study (SHHS) were included in this analysis. Variable definitions of OSA were determined using an Apnea Hypopnea Index (AHI) threshold of 5 per hour, 15 per hour, or the presence of any comorbidity (hypertension, ischemic heart disease, stroke, mood disorders, impairment of cognition, or sleepiness) when the AHI was between 5 to 15 per hour. Variable hypopnea definitions based upon degree of oxygen desaturation and associated arousals were considered. Results In the SHHS dataset, the Receiver Operating Characteristics (ROC) for a SLIM score threshold of 9 for men and 5 for women was good when OSA was defined by AHI > 5 per hour (hypopneas with either > 3% oxygen desaturation or arousals). Specifically, the ROC was 0.72 (95% Confidence Intervals [CI] 0.70; 0.74) with a Positive Predictive Value [PPV] of 0.98 and Likelihood Ratio of a positive test (LR+) of 11.3. The LR+ (6.0) and PPV (0.92) were also good when an AHI of 5 per hour threshold was adopted with hypopneas scored using the minimum 3% oxygen desaturation alone. Similarly, the ROC was good 0.74 (95%CI 0.73; 0.76) with a Positive Predictive Value [PPV] of 0.98 and Likelihood Ratio of a positive test (LR+) of 11.3. The LR+ (8.9) and PPV (0.81) were also good in the presence of comorbidities when AHI was 5 to 15 per hour using > 4% oxygen desaturation alone. Conclusion The EHR-extractable tool can be an actionable tool for case-identification of patients needing a referral for sleep study in a community-based population. Such an approach could facilitate an automated, rather than manual, OSA screening approach aimed at managing population health. Support HL138377

scholarly journals The Child Behavior Checklist Together with the ADHD Rating Scale Can Diagnose ADHD in Korean Community-Based Samples

2005 ◽  
Vol 50 (12) ◽  
pp. 802-805 ◽  
Author(s):  
Jae-Won Kim ◽  
Ki-Hong Park ◽  
Keun-Ah Cheon ◽  
Boong-Nyun Kim ◽  
Soo-Churl Cho ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Child Behavior ◽  
Predictive Value ◽  
Child Behavior Checklist ◽  
Rating Scale ◽  
Attention Problems ◽  
School Students ◽  
Case Definitions ◽  
Community Based ◽  
Clinical Method

Objective: The purpose of this study was to examine the clinical validities and efficiencies of the Child Behavior Checklist (CBCL) and the ADHD Rating Scale-IV (ARS) in identifying children with attention-deficit hyperactivity disorder (ADHD) in Korean community-based samples. Method: A large sample of elementary school students ( n = 1668) participated in this study. We used the CBCL and the ARS as the screening instruments. Diagnoses were determined by clinical psychiatric interviews and confirmed by DSM-IV–based structured interviews. Results: Of the 46 subjects who underwent clinical psychiatric interviews, 33 were diagnosed as having ADHD. A T score of 60 with regard to the Attention Problems profile of the CBCL resulted in a reasonable level of sensitivity or positive predictive value in the diagnosis of ADHD. In both the parent and teacher reports of the ARS, 90th percentile cut-off points resulted in a high level of predictive value. The highest levels of specificity and positive predictive value were obtained when we combined the CBCL ( T ≥ 60 in Attention Problems) and the ARS (parent–teacher total ≥ 90th percentile) reports. Conclusions: These findings suggest that the combined use of the CBCL and the ARS could serve as a rapid and useful clinical method of predicting or even diagnosing children with ADHD in epidemiologic case definitions.

scholarly journals Bayesian updating and sequential testing: overcoming inferential limitations of screening tests

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jacques Balayla
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Bayesian Updating ◽  
Bayes Theorem ◽  
Disease Prevalence ◽  
Positive Test ◽  
Screening Tests ◽  
Sequential Testing ◽  
Widespread Application ◽  
Test Probability

Abstract Background Bayes’ theorem confers inherent limitations on the accuracy of screening tests as a function of disease prevalence. Herein, we establish a mathematical model to determine whether sequential testing with a single test overcomes the aforementioned Bayesian limitations and thus improves the reliability of screening tests. Methods We use Bayes’ theorem to derive the positive predictive value equation, and apply the Bayesian updating method to obtain the equation for the positive predictive value (PPV) following repeated testing. We likewise derive the equation which determines the number of iterations of a positive test needed to obtain a desired positive predictive value, represented graphically by the tablecloth function. Results For a given PPV ($$\rho$$ ρ ) approaching k, the number of positive test iterations needed given a prevalence of disease ($$\phi$$ ϕ ) is: $$n_i =\lim _{\rho \rightarrow k}\left\lceil \frac{ln\left[ \frac{\rho (\phi -1)}{\phi (\rho -1)}\right] }{ln\left[ \frac{a}{1-b}\right] }\right\rceil \qquad \qquad (1)$$ n i = lim ρ → k l n ρ ( ϕ - 1 ) ϕ ( ρ - 1 ) l n a 1 - b ( 1 ) where $$n_i$$ n i = number of testing iterations necessary to achieve $$\rho$$ ρ , the desired positive predictive value, ln = the natural logarithm, a = sensitivity, b = specificity, $$\phi$$ ϕ = disease prevalence/pre-test probability and k = constant. Conclusions Based on the aforementioned derivation, we provide reference tables for the number of test iterations needed to obtain a $$\rho (\phi )$$ ρ ( ϕ ) of 50, 75, 95 and 99% as a function of various levels of sensitivity, specificity and disease prevalence/pre-test probability. Clinical validation of these concepts needs to be obtained prior to its widespread application.

scholarly journals Utility of Apical Lung Assessment on Computed Tomography Angiography as a COVID-19 Screen in Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3765-3769
Author(s):  
Charles Esenwa ◽  
Ji-Ae Lee ◽  
Taha Nisar ◽  
Anna Shmukler ◽  
Inessa Goldman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Computed Tomography Angiography ◽  
Predictive Value ◽  
Screening Tool ◽  
Clinical Symptoms ◽  
Shortness Of Breath ◽  
Patient Reported

Background and Purpose: Evaluation of the lung apices using computed tomography angiography of the head and neck during acute ischemic stroke (AIS) can provide the first objective opportunity to screen for coronavirus disease 2019 (COVID-19). Methods: We performed an analysis assessing the utility of apical lung exam on computed tomography angiography for COVID-19–specific lung findings in 57 patients presenting with AIS. We measured the diagnostic accuracy of apical lung assessment alone and in combination with patient-reported symptoms and incorporate both to propose a COVID-19 era AIS algorithm. Results: Apical lung assessment when used in isolation, yielded a sensitivity of 0.67, specificity of 0.93, positive predictive value of 0.19, negative predictive value of 0.99, and accuracy of 0.92 for the diagnosis of COVID-19, in patients presenting to the hospital for AIS. When combined with self-reported clinical symptoms of cough or shortness of breath, sensitivity of apical lung assessment improved to 0.83. Conclusions: Apical lung assessment on computed tomography angiography is an accurate screening tool for COVID-19 and can serve as part of a combined screening approach in AIS.

scholarly journals The Diagnostic Value of the Clarke Sign in Assessing Chondromalacia Patella

2008 ◽  
Vol 43 (2) ◽  
pp. 190-196 ◽  
Author(s):  
Scott T. Doberstein ◽  
Richard L. Romeyn ◽  
David M. Reineke
Keyword(s):  
Likelihood Ratio ◽  
Predictive Value ◽  
Arthroscopic Surgery ◽  
Diagnostic Value ◽  
Quadriceps Muscle ◽  
Positive Test ◽  
Visual Evidence ◽  
Chondromalacia Patella ◽  
History Of ◽  
Arthroscopic Examination

Abstract Context: Various techniques have been described for assessing conditions that cause pain at the patellofemoral (PF) joint. The Clarke sign is one such test, but the diagnostic value of this test in assessing chondromalacia patella is unknown. Objective: To (1) investigate the diagnostic value of the Clarke sign in assessing the presence of chondromalacia patella using arthroscopic examination of the PF joint as the “gold standard,” and (2) provide a historical perspective of the Clarke sign as a clinical diagnostic test. Design: Validation study. Setting: All patients of one of the investigators who had knee pain or injuries unrelated to the patellofemoral joint and were scheduled for arthroscopic surgery were recruited for this study. Patients or Other Participants: A total of 106 otherwise healthy individuals with no history of patellofemoral pain or dysfunction volunteered. Main Outcome Measure(s): The Clarke sign was performed on the surgical knee by a single investigator in the clinic before surgery. A positive test was indicated by the presence of pain sufficient to prevent the patient from maintaining a quadriceps muscle contraction against manual resistance for longer than 2 seconds. The preoperative result was compared with visual evidence of chondromalacia patella during arthroscopy. Results: Sensitivity was 0.39, specificity was 0.67, likelihood ratio for a positive test was 1.18, likelihood ratio for a negative test was 0.91, positive predictive value was 0.25, and negative predictive value was 0.80. Conclusions: Diagnostic validity values for the use of the Clarke sign in assessing chondromalacia patella were unsatisfactory, supporting suggestions that it has poor diagnostic value as a clinical examination technique. Additionally, an extensive search of the available literature for the Clarke sign reveals multiple problems with the test, causing significant confusion for clinicians. Therefore, the use of the Clarke sign as a routine part of a knee examination is not beneficial, and its use should be discontinued.

scholarly journals Self-Management Maintenance Inhalation Therapy With eHealth (SELFIE): Observational Study on the Use of an Electronic Monitoring Device in Respiratory Patient Care and Research (Preprint)

2019 ◽  
Author(s):  
Esther Kuipers ◽  
Charlotte C Poot ◽  
Michel Wensing ◽  
Niels H Chavannes ◽  
Peter AGM de Smet ◽  
...  
Keyword(s):  
Observational Study ◽  
Positive Predictive Value ◽  
Health Care Providers ◽  
Predictive Value ◽  
Electronic Monitoring ◽  
False Negative ◽  
Inhalation Therapy ◽  
Care Providers ◽  
Convenience Sample ◽  
Patient Reported

BACKGROUND Electronic inhalation monitoring devices (EIMDs) are available to remind patients with respiratory diseases to take their medication and register inhalations for feedback to patients and health care providers as well as for data collection in research settings. OBJECTIVE This study aimed to assess the validity as well as the patient-reported usability and acceptability of an EIMD. METHODS This observational study planned to include 21 community pharmacies in the Netherlands. Patient-reported inhalations were collected and compared to EIMD registrations to evaluate the positive predictive value of these registrations as actual patient inhalations. Patients received questionnaires on their experiences and acceptance. RESULTS A convenience sample of 32 patients was included from across 18 pharmacies, and 932 medication doses were validated. Of these, 796 registrations matched with patient-reported use (true-positive, 85.4%), and 33 inhalation registrations did not match with patient-reported use (false-positive, 3.5%). The positive predictive value was 96.0%, and 103 patient-reported inhalations were not recorded in the database (false-negative, 11.1%). Overall, patients considered the EIMD to be acceptable and easy to use, but many hesitated to continue its use. Reminders and motivational messages were not appreciated by all users, and more user-tailored features in the app were desired. CONCLUSIONS Patients’ interaction with the device in real-world settings is critical for objective measurement of medication adherence. The positive predictive value of this EIMD was found to be acceptable. However, patients reported false-negative registrations and a desire to include more user-tailored features to increase the usability and acceptability of the EIMD.

scholarly journals Prevalence and identification of anxiety disorders in pregnancy: the diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2)

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e023766 ◽  
Author(s):  
Selina Nath ◽  
Elizabeth G Ryan ◽  
Kylee Trevillion ◽  
Debra Bick ◽  
Jill Demilew ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Positive Predictive Value ◽  
Anxiety Disorders ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Stratified Sampling ◽  
Generalised Anxiety Disorder ◽  
Population Prevalence

ObjectiveTo estimate the population prevalence of anxiety disorders during pregnancy and investigate the diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2) for a) GAD and b) any anxiety disorder.DesignCross-sectional survey using a stratified sampling design. Sampling weights were used in the analysis to adjust for the bias introduced by the stratified sampling.SettingInner-city maternity service, South London.Participants545 pregnant women were interviewed after their first antenatal appointment; 528 provided answers on the GAD-2 questions.Main outcome measuresDiagnosis generated by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (SCID).ResultsPopulation prevalence of anxiety disorders was 17% (95% CI 12% to 21%): 5% (95% CI 3% to 6%) for GAD, 4% (95% CI 2% to 6%) for social phobia, 8% (95% CI 5% to 11%) for specific phobia and 2% (95% CI 1% to 4%) for obsessive-compulsive disorder. Post-traumatic stress disorder (PTSD) prevalence was unclear due to higher levels of reluctance to respond to PTSD interview questions but sensitivity analyses suggest population prevalence maybe up to 4% (95% CI 2% to 6%). Weighted sensitivity of GAD-2 for GAD (cut-off ≥3) was 69%, specificity 91%, positive predictive value 26%, negative predictive value 98% and likelihood ratio 7.35. For any anxiety disorder the weighted sensitivity was 26%, specificity 91%, positive predictive value 36%, negative predictive value 87% and likelihood ratio 2.92.ConclusionsAnxiety disorders are common but GAD-2 generates many false positives and may therefore be unhelpful in maternity services.

scholarly journals Criteria for undernutrition screening in hospitalised infants under 6 months: a diagnostic accuracy study in a resource-poor setting

2019 ◽  
Vol 105 (6) ◽  
pp. 524-529 ◽  
Author(s):  
Ifeyinwa Obiageli Ezeofor ◽  
Ada Lizbeth Garcia ◽  
Charlotte Margaret Wright
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Resource Poor Setting ◽  
High Risk Population ◽  
Diagnostic Accuracy Study ◽  
Z Scores ◽  
Accuracy Study ◽  
Weight Faltering

PurposeWe aimed to describe the prevalence of undernutrition in hospitalised infants aged under 6 months and test the utility of simple index measures to detect undernutrition.DesignDiagnostic accuracy study: weight, length, mid-upper arm circumference (MUAC), triceps and subscapular skinfolds were measured in infants aged 2 weeks to 6 months admitted to a Teaching Hospital in Enugu, Nigeria. Index criteria: low (<−2SD) weight-for-age Z-scores (WAZ), weight-for-length Z-scores (WLZ); MUAC <11 cm. Reference definition: weight faltering (conditional weight gain below fifth percentile for healthy Nigerian infants) or sum of skinfolds (SSF) <10 mm.ResultsOf 125 hospitalised infants, only 5% (6) were admitted specifically for undernutrition, but low SSF were found in 33% (41) and, 24% (25) with known birth weight had weight faltering, giving an undernutrition prevalence of 36%. Low WAZ was the most discriminating predictor of undernutrition (sensitivity 69%, positive predictive value 86%, likelihood ratio 5.5; area under receiver operator curves 0.90) followed by MUAC (73%, 73%, 4.9; 0.86), while WLZ performed least well (49%, 67%, 2.9; 0.84). Where both MUAC and WAZ were low, there was sensitivity 90%, positive predictive value 82% and likelihood ratio 8.7.ConclusionsInfants aged under 6 months admitted to hospital in Nigeria had a high prevalence of undernutrition. In young, high-risk population, a low WAZ alone was a valuable screening criterion, while combining weight with MUAC gave even higher discrimination. Measurement of length to calculate WLZ was a less useful predictor in this population.

Invasive screening for lower extremity peripheral artery disease: Killing two birds with one stone?

Vascular ◽  
2019 ◽  
Vol 28 (2) ◽  
pp. 196-202 ◽  
Author(s):  
Savas Celebi ◽  
Ozlem Ozcan Celebi ◽  
Serkan Çetin ◽  
Elif Hande Ozcan Cetin ◽  
Erdem Diker ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Positive Predictive Value ◽  
Lower Extremity ◽  
Likelihood Ratio ◽  
Peripheral Artery Disease ◽  
Predictive Value ◽  
Routine Screening ◽  
Smoking History ◽  
Peripheral Artery ◽  
Artery Disease

Objectives There is substantial evidence that the majority of cases of lower extremity peripheral artery disease are undetected. As a result, there is great interest in the detection of lower extremity peripheral artery disease through routine screening. However, routine screening of lower extremity peripheral artery disease is still debated. Methods In our cross-sectional study, we included 200 consecutive patients with symptoms suggestive of angina who were undergoing coronary angiography. Irrespective of intermittent claudication, we subsequently performed peripheral angiography to detect lower extremity peripheral artery disease. The predictors of lower extremity peripheral artery disease were analyzed, and the diagnostic utility of these predictors and their combinations were determined. Additionally, the determinants of the amount of radio-opaque material used and peripheral fluoroscopy time were investigated. Results The overall prevalence of lower extremity peripheral disease was 16%. Being older than 65 years, having coronary artery disease and smoking history remained significant predictors after adjusting for other well-known parameters. Having the combination of age  ≥65 and smoking was associated with a positive predictive value of 50% (likelihood ratio 5.06), and having all of the predictors was associated with a positive predictive value of 100% (likelihood ratio >1000). Conclusions Routine screening for lower extremity peripheral disease patients undergoing coronary angiography may be useful in selected patients.

scholarly journals The diagnostic utility of serum IgG4 concentrations in IgG4-related disease

2014 ◽  
Vol 74 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Mollie N Carruthers ◽  
Arezou Khosroshahi ◽  
Tamara Augustin ◽  
Vikram Deshpande ◽  
John H Stone
Keyword(s):  
Positive Predictive Value ◽  
Electronic Medical Records ◽  
Predictive Value ◽  
Medical Records ◽  
Elevated Serum ◽  
Predictive Values ◽  
Test Characteristics ◽  
Igg4 Related Disease ◽  
Serum Igg4 ◽  
Sensitivity Specificity

ObjectivesWe evaluated the sensitivity, specificity and positive and negative predictive values of elevated serum IgG4 concentrations for the diagnosis of IgG4-RD.MethodsBetween 2001 and 2011, 190 unique patients had elevated serum IgG4 measurements. We reviewed electronic medical records to determine the indication for IgG4 measurement and underlying clinical diagnosis. Additionally, we reviewed the records of 190 other randomly selected patients from a pool of 3360 with normal results, to evaluate test characteristics of the IgG4 measurement.ResultsAmong 380 patients analysed, 72 had either probable or definite IgG4-RD. Sixty-five of the 72 IgG4-RD patients had elevated serum IgG4 concentrations (mean: 405 mg/dL; range 140–2000 mg/dL), for a sensitivity of 90%. Among the 308 subjects without IgG4-RD, 125 had elevated IgG4 (mean: 234 mg/dL; range 135–1180 mg/dL) and 183 had normal IgG4 concentrations, for a specificity of 60%. The negative predictive value of a serum IgG4 assay was 96%, but the positive predictive value only 34%. Analysis of the serum IgG4/total IgG ratio did not improve these test characteristics. Doubling the cutoff for IgG4 improved specificity (91%) but decreased sensitivity to 35%.DiscussionMultiple non-IgG4-RD conditions are associated with elevated serum IgG4, leading to poor specificity and low positive predictive value for this test. A substantial subset of patients with biopsy-proven IgG4-RD do not have elevated serum IgG4. Neither doubling the cutoff for serum IgG4 nor examining the serum IgG4/IgG ratio improves the overall test characteristics for the diagnosis of IgG4-RD.

scholarly journals NON-INVASIVE TOOLS TO ASSESS THE RISK OF VARICES-NEEDING-TREATMENT IN CIRRHOSIS SECONDARY TO HCV

2021 ◽  
Vol 71 (1) ◽  
pp. 12-17
Author(s):  
Laima Alam ◽  
Farrukh Saeed
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Chronic Hepatitis C ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Screening Method ◽  
Military Hospital ◽  
Non Invasive

Objective: To assess the non-invasive biomarkers of fibrosis for predicting varices-needing-treatment in patients with cirrhosis secondary to chronic-hepatitis-C. Study Design: Cross sectional comparative study. Place and Duration of Study: Department of Gastroenterology, Pak Emirates Military Hospital Rawalpindi, from Jan 2017 to Dec 2017. Methodology: A total of 153 patients aged 18-79 with cirrhosis, whether compensated or decompensated, secondary to chronic-hepatitis-C were enrolled. Relevant serum tests were used to calculate non-invasive fibrosis indices and their diagnostic performance to predict the presence of varices and varices-needing-treatment was calculated. Results: King’s score showed the best performance in detecting varices due to high positive predictive value of 96.4% and positive likelihood ratio of 2.4. Overall, all the non-invasive fibrosis indices exhibited good performance with positive predictive value >85% but none could rule out the presence of varices with adequate reliability due to low negative-predictive-value (<65%). King’s score exhibited relatively higher positive-predictivevalue (70%) and negative predictive value (51.1%) and the lowest negative-likelihood-ratio (0.6) for predicting varices needing treatment. Taken together, none of the non-invasive biomarkers of fibrosis could predict the presence of varices-needing-treatment with adequate accuracy due to low positive-predictive-value (<85%) andlow negative-predictive-value (<65%). Conclusion: The calculated non-invasive biomarkers of fibrosis and their optimum cutoff values showed modest accuracy for predicting varices and varices-needing-treatment. These indices may be used as first-line screening method for segregation of clinically significant portal hypertension and high risk esophageal varices-needingtreatment but may not be able to replace the gold standards like Fibroscan liver and Hepatic Venous Pressure Gradient measurements.

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