Predictive value and validation of the NEECHAM Confusion Scale using DSM-IV criteria for delirium as gold standard

Abstract Introduction: Rising prevalence and undetected perinatal depression has been described in many countries and report that treating those who are already symptomatic, more effort should be targeted towards screening strategies to identify perinatal depression at the early stage. The Whooley questions is the recommended case finding strategy to aid the identification of perinatal depression. An official Chinese version has not been validated. The aim of this study was to evaluate the diagnostic accuracy and stability of the translated Whooley questionnaire against the gold standard measurement during pregnancy (antenatal) and early after pregnancy (postnatal).Materials and method: This observational study recruited 131 pregnant women from antenatal clinics in a hospital setting from September 2019 till May 2020 in Hong Kong. We translated the Whooley questionnaire in Chinese and evaluated self-reported responses against an interviewer assessed diagnostic standard (DSM-IV criteria) among 107 women receiving antenatal care at 26-28 weeks gestation. We calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio, with DSM-IV diagnosis taken as the gold standard.Results: Antenatally, the Chinese Whooley questions had a sensitivity of 79% (95% CI 54.4-93.9), a specificity of 97% (95% CI 90.4-99.3), a positive likelihood ratio of 23.2 (95% CI 7.4-72.1) and a negative likelihood ratio of 0.2 (95% CI 0.1-0.5) in identifying perinatal depression. Conclusion: Prevalence of depression in pregnancy have increased and screening early remains a significant tool in Western countries. The translated Chinese Whooley questionnaire appears to have acceptable diagnostic accuracy and can be implemented into health services among Chinese population as only requiring two yes/no questions.

Download Full-text

Development of an Electronic Algorithm to Identify Inappropriate Antibiotic Prescribing for Pediatric Pharyngitis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.728 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s188-s189

Author(s):

Jeffrey Gerber ◽

Robert Grundmeier ◽

Keith Hamilton ◽

Lauri Hicks ◽

Melinda Neuhauser ◽

...

Keyword(s):

Predictive Value ◽

Gold Standard ◽

Antibiotic Stewardship ◽

Chart Review ◽

Antibiotic Use ◽

Audit And Feedback ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Tract Infections ◽

The Impact

Background: Antibiotic overuse contributes to antibiotic resistance and unnecessary adverse drug effects. Antibiotic stewardship interventions have primarily focused on acute-care settings. Most antibiotic use, however, occurs in outpatients with acute respiratory tract infections such as pharyngitis. The electronic health record (EHR) might provide an effective and efficient tool for outpatient antibiotic stewardship. We aimed to develop and validate an electronic algorithm to identify inappropriate antibiotic use for pediatric outpatients with pharyngitis. Methods: This study was conducted within the Children’s Hospital of Philadelphia (CHOP) Care Network, including 31 pediatric primary care practices and 3 urgent care centers with a shared EHR serving >250,000 children. We used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify encounters for pharyngitis at any CHOP practice from March 15, 2017, to March 14, 2018, excluding those with concurrent infections (eg, otitis media, sinusitis), immunocompromising conditions, or other comorbidities that might influence the need for antibiotics. We randomly selected 450 features for detailed chart abstraction assessing patient demographics as well as practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for evaluating the electronic algorithm. Criteria for appropriate use included streptococcal testing, use of penicillin or amoxicillin (absent β-lactam allergy), and a 10-day duration of therapy. Results: In 450 patients, the median age was 8.4 years (IQR, 5.5–9.0) and 54% were women. On chart review, 149 patients (33%) received an antibiotic, of whom 126 had a positive rapid strep result. Thus, based on chart review, 23 subjects (5%) diagnosed with pharyngitis received antibiotics inappropriately. Amoxicillin or penicillin was prescribed for 100 of the 126 children (79%) with a positive rapid strep test. Of the 126 children with a positive test, 114 (90%) received the correct antibiotic: amoxicillin, penicillin, or an appropriate alternative antibiotic due to b-lactam allergy. Duration of treatment was correct for all 126 children. Using the electronic algorithm, the proportion of inappropriate prescribing was 28 of 450 (6%). The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were sensitivity (99%, 422 of 427); specificity (100%, 23 of 23); positive predictive value (82%, 23 of 28); and negative predictive value (100%, 422 of 422). Conclusions: For children with pharyngitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. Future work should validate this approach in other settings and develop and evaluate the impact of an audit and feedback intervention based on this tool.Funding: NoneDisclosures: None

Download Full-text

Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.510 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s32-s32

Author(s):

Ebbing Lautenbach ◽

Keith Hamilton ◽

Robert Grundmeier ◽

Melinda Neuhauser ◽

Lauri Hicks ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Predictive Value ◽

Gold Standard ◽

Chart Review ◽

Acute Bronchitis ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Diagnostic Codes ◽

Icd 10 ◽

The Impact

Background: Antibiotic resistance has increased at alarming rates, driven predominantly by antibiotic overuse. Although most antibiotic use occurs in outpatients, antimicrobial stewardship programs have primarily focused on inpatient settings. A major challenge for outpatient stewardship is the lack of accurate and accessible electronic data to target interventions. We sought to develop and validate an electronic algorithm to identify inappropriate antibiotic use for outpatients with acute bronchitis. Methods: This study was conducted within the University of Pennsylvania Health System (UPHS). We used ICD-10 diagnostic codes to identify encounters for acute bronchitis at any outpatient UPHS practice between March 15, 2017, and March 14, 2018. Exclusion criteria included underlying immunocompromising condition, other comorbidity influencing the need for antibiotics (eg, emphysema), or ICD-10 code at the same visit for a concurrent infection (eg, sinusitis). We randomly selected 300 (150 from academic practices and 150 from nonacademic practices) eligible subjects for detailed chart abstraction that assessed patient demographics and practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for assessment of the electronic algorithm. Because antibiotic use is not indicated for this study population, appropriateness was assessed based upon whether an antibiotic was prescribed or not. Results: Of 300 subjects, median age was 61 years (interquartile range, 50–68), 62% were women, 74% were seen in internal medicine (vs family medicine) practices, and 75% were seen by a physician (vs an advanced practice provider). On chart review, 167 (56%) subjects received an antibiotic. Of these subjects, 1 had documented concern for pertussis and 4 had excluding conditions for which there were no ICD-10 codes. One received an antibiotic prescription for a planned dental procedure. Thus, based on chart review, 161 (54%) subjects received antibiotics inappropriately. Using the electronic algorithm based on diagnostic codes, underlying and concurrent conditions, and prescribing data, the number of subjects with inappropriate prescribing was 170 (56%) because 3 subjects had antibiotic prescribing not noted based on chart review. The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were the following: sensitivity, 100% (161 of 161); specificity, 94% (130 of 139); positive predictive value, 95% (161 of 170); and negative predictive value, 100% (130 of 130). Conclusions: For outpatients with acute bronchitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. This algorithm could be used to efficiently assess prescribing among practices and individual clinicians. The impact of interventions based on this algorithm should be tested in future studies.Funding: NoneDisclosures: None

Download Full-text

Diagnostic Accuracy of HRCT Chest in Detection of Covid-19 Infection Taking PCR as Gold Standard

10.53350/pjmhs211561679 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1679-1681

Author(s):

Afaque Ali ◽

Majid Shaikh ◽

Ahsanullah . ◽

Adeel Ahmed ◽

Abid Ali Sahito ◽

...

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Gold Standard ◽

Cross Sectional Study ◽

Radiology Department ◽

High Resolution Computed Tomography ◽

Cross Sectional ◽

Head Of Department

Objective: To determine the diagnostic accuracy of High-resolution computed tomography (HRCT) chest in detection of covid-19 infection taking PCR as gold standard. Study Design: Cross-sectional study Setting: Radiology department of Tabba Hospital, Karachi. Duration: From March 2019 to September 2020 Material and Methods: All the clinically suspected patients of covid-19, of any age, both genders and those referred to radiology for High-resolution computed tomography (HRCT) chest to detect the covid-19 infection were included. After two days, patients’ PCR reports were collected from the ward, after taking informed consent and permission from head of department. The diagnostic accuracy of HRCT was established with respect to sensitivity, PPV, NPV, and specificity by taking PCR as gold standard. All the information was collected via study proforma. Results: Total 70 patients suspected for COVID-19 were studied, and the patients’ mean age was 58.23±9.52 years. Males were in majority 54(77.1%). As per HRCT findings, COVID-19 infection was positive in 46 patients, however, 48 patients were detected positive for COVID-19 infection as per PCR findings. In the detection of COVID-19 infection, HRCT chest showed sensitivity of 91%, specificity of 90%, PPV of 83%, NPV of 84% and diagnostic accuracy of 94%; by taking PCR as gold standard. Conclusion: High-resolution computed tomography (HRCT) is a reliable diagnostic approach in promptly detecting the COVID-19; with 91% sensitivity, 90% specificity, 83% positive predictive value, 84% negative predictive value and 94% diagnostic accuracy. Keywords: Accuracy, HRCT, COVID-19

Download Full-text

The utility of rapid Group A streptococcus molecular testing compared with throat culture for the diagnosis of Group A streptococcal pharyngitis in a high-incidence rheumatic fever population.

Journal of Clinical Microbiology ◽

10.1128/jcm.00978-21 ◽

2021 ◽

Author(s):

Amanda Taylor ◽

Susan Morpeth ◽

Rachel Webb ◽

Susan Taylor

Keyword(s):

New Zealand ◽

Rheumatic Fever ◽

Predictive Value ◽

Gold Standard ◽

Molecular Test ◽

Throat Culture ◽

High Incidence ◽

Group A ◽

Sensitivity Specificity ◽

Culture Negative

Background: Group A Streptococcus (GAS) causes significant morbidity and mortality in New Zealand and is responsible for invasive disease and immune sequelae including acute Rheumatic Fever (ARF). Early treatment of GAS pharyngitis reduces the risk of ARF. In settings with a high-burden of GAS disease, a rapid GAS pharyngitis diagnostic test with a strong negative predictive value is needed to enable prompt and accurate treatment. Methods: This prospective study compares the Xpert® Xpress Strep A molecular test (Cepheid) to throat culture and a second molecular method, the BioGX Group A Streptococcus -OSR for BD MAX TM for the diagnosis of GAS pharyngitis. Throat swabs were collected from the emergency department and wards of Middlemore Hospital, New Zealand. The BioGX Group A Streptococcus - OSR for BD MAX TM , contributes to the composite gold-standard: throat culture or both molecular methods positive. Basic demographic, clinical and laboratory data was collected. Results: 205/214 swabs were suitable for analysis. 28/205 (13.7%) were GAS culture positive, 45/205 (22%) Xpert® Xpress Strep A positive and 38/205 (18.5%) BioGX positive. Compared to culture, the sensitivity, specificity, positive and negative predictive values of the Xpert® Xpress Strep A molecular test were 100%, 90.4%, 62.2% and 100%, respectively. Compared to the composite gold-standard, the sensitivity, specificity, PPV and NPV and were 100%, 95.8%, 84.4% and 100% respectively. 17 samples were Xpert® Xpress positive but culture-negative; 6 of these 17 swabs represent true positives with evidence of recent GAS infection. Ten samples were culture negative but both Xpert® Xpress and BioGX positive. Conclusion: The Xpert® Xpress Strep A molecular test is highly sensitive with a strong negative predictive value and rapid turnaround time. It can be safely introduced as a first line test for throat swabs in a high-incidence ARF population.

Download Full-text

Accuracy of Computed Tomography for Detection of COVID-19 among Suspected Patients

10.53350/pjmhs211592474 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2474-2476

Author(s):

Maham Munir Awan ◽

Afshan Noreen ◽

Farah Kalsoom ◽

Muhammad Tahir ◽

Umaima Majeed ◽

...

Keyword(s):

Computed Tomography ◽

Predictive Value ◽

Gold Standard ◽

Radiology Department ◽

True Positive ◽

Test Results ◽

Rt Pcr ◽

Radiological Society ◽

Medical University ◽

Pcr Test

Objective: To determine the accuracy of CT chest in diagnosis of COVID-19 taking RT-PCR-testing as gold standard. Materials and Methods: A total of 150 patients of suspicion of COVID-19 who were referred for CT Chest in Radiology Department of Nishtar Medical University Multan from June-2020 to May-2021 were included. In all patients, two RT-PCR test results were obtained with 7 days of admission in hospital. Presence of any of these positive was labelled as COVID-19 infection. CT chest was performed in all patients within 2 days of admission in hospital using 128 slices CT scan machine. The diagnosis of COVID-19 infection was made according to the recommendations by Radiological Society of North America (RSNA) protocol. Results: Mean age was 51.3±14.7 years. 78 (52%) patients were male and 72 (48%) patients were female. RTPCR test was positive in 89 (59.3%) patients. While the CT chest findings were suggestive of COVID-19 infection in 130 (86.7%) patients. The sensitivity of CT chest was 95.5%, specificity 26.2%, PPV wad 65.4% and NPV was 80.0%. Conclusion: CT chest has a very good sensitivity for detection of COVID-19, it can be used as a rapid diagnostic tool especially in areas of pandemic. However, the specificity of CT chest is low, that can limit its use in low COVID-19 affected areas. Keywords: COVID-19, Computed tomography, False Positive, True Positive, Positive Predictive Value, Negative Predictive Value.

Download Full-text

Agreement in the diagnosis of dental fluorosis in central incisors performed by a standardized photographic method and clinical examination

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2009000500008 ◽

2009 ◽

Vol 25 (5) ◽

pp. 1017-1024 ◽

Cited By ~ 11

Author(s):

Carolina Castro Martins ◽

Loliza Chalub ◽

Ynara Bosco Lima-Arsati ◽

Isabela Almeida Pordeus ◽

Saul Martins Paiva

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Clinical Examination ◽

Predictive Value ◽

Gold Standard ◽

Dental Fluorosis ◽

Digital Camera ◽

High Specificity ◽

Photographic Method ◽

Pediatric Dentists

The aim of this study was to assess agreement in the diagnosis of dental fluorosis performed by a standardized digital photographic method and a clinical examination (gold standard). 49 children (aged 7-9 years) were clinically evaluated by a trained examiner for the assessment of dental fluorosis. Central incisors were evaluated for the presence or absence of dental fluorosis and were photographed with a digital camera. Photographs were presented to three pediatric dentists, who examined the images. Data were analyzed using Cohen's kappa and validity values. Agreement in the diagnosis performed by the photographic method and clinical examination was good (0.67) and accuracy was 83.7%. The prevalence of dental fluorosis was reported to be higher in the clinical examination (49%) compared with the photographic method (36.7%). The photographic method presented higher specificity (96%) than sensitivity (70.8%), a positive predictive value (PPV) of 94.4% and a negative predictive value (NPV) of 77.4%. The diagnosis of dental fluorosis performed using the photographic method presented high specificity and PPV, which indicates that the method is reproducible and reliable for recording dental fluorosis.

Download Full-text

Prevalence of feline coronavirus antibodies in cats in Bursa province, Turkey, by an enzyme-linked immunosorbent assay

Journal of Feline Medicine and Surgery ◽

10.1016/j.jfms.2009.02.008 ◽

2009 ◽

Vol 11 (10) ◽

pp. 881-884 ◽

Cited By ~ 5

Author(s):

Annamaria Pratelli ◽

Kadir Yesilbag ◽

Marcello Siniscalchi ◽

Ebru Yalçm ◽

Zeki Yilmaz

Keyword(s):

Immunosorbent Assay ◽

Predictive Value ◽

Gold Standard ◽

Population Based ◽

Standard Test ◽

Enzyme Linked Immunosorbent Assay ◽

Serum Samples ◽

High Association ◽

Gold Standard Test ◽

Feline Coronavirus

Feline sera from Bursa province (Turkey) were assayed for coronavirus antibody using an enzyme-linked immunosorbent assay (ELISA). The study was performed on 100 sera collected from cats belonging to catteries or community shelters and to households. The serum samples were initially tested with the virus neutralisation (VN) test and the results were then compared with the ELISA. The VN yielded 79 negative and 21 positive sera but the ELISA confirmed only 74 as negative. The ELISA-negative sera were also found to be free of feline coronoviruses-specific antibodies by Western blotting. Using the VN as the gold standard test, ELISA had a sensitivity of 100% and a specificity of 93.6%, with an overall agreement of 95%. The Kappa (κ) test indicated high association between the two tests (κ=0.86, 95% confidence interval (CI) 0.743–0.980). The positive predictive value (PPV) was 0.8, and the negative predictive value (NPV) was 0.93. The prevalence of FCoV II antibodies in the sampled population based on the gold standard was 62% (95% CI 0.44–0.77) among multi-cat environments, and 4% (95% CI 0.01–0.11) among single cat households.

Download Full-text

Correlation of clinical examination, ultrasound, magnetic resonance imaging and arthroscopy as diagnostic tools in shoulder pathology

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200473 ◽

2020 ◽

Vol 6 (2) ◽

pp. 247

Author(s):

Sondipon Biswas ◽

Naman Kanodia ◽

Rajat Tak ◽

Siddharth Agrawal ◽

Kiran Shankar Roy

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Gold Standard ◽

Shoulder Arthroscopy ◽

Resonance Imaging ◽

Shoulder Pathologies

Background: Shoulder pathologies can cause significant pain, discomfort, and affect the activity of daily living. The aim of this study was to compare the efficacy of clinical examination, ultrasound, magnetic resonance imaging (MRI) with shoulder arthroscopy in diagnosing various shoulder pathologies, considering shoulder arthroscopy as the gold standard tool.Methods: This was a prospective, comparative study conducted over 35 patients, between 18-75 years of age presenting with chronic shoulder pain or instability of more than 2 months duration. All patients were examined clinically, followed by high resolution ultrasound, MRI, arthroscopy of the affected shoulder.Results: The sensitivity and specificity of ultrasonography (USG) for diagnosing full thickness tear was 100% each and for MRI was 88% and 100% respectively. For subacromial impingement USG had sensitivity of 66.67%, specificity of 94.12%, positive predictive value of 50% and negative predictive value of 88.89%. For rotator cuff tear USG had sensitivity of 92.86%, specificity of 50%, positive predictive value of 81.25% and negative predictive value of 75% considering shoulder arthroscopy as gold standard.Conclusions: USG and MRI both are sensitive techniques for diagnosing of rotator cuff pathologies. USG has high accuracy in diagnosing partial thickness tears as compare to MRI. MRI proved to be superior in estimation of site and extent of tear. Considering shoulder arthroscopy as gold standard, it can be reserved for patients with suspicious of USG/MRI findings or those who may need surgical intervention simultaneously.

Download Full-text

Diagnostic Accuracy of Three-dimensional Ultrasonography in Detection of Endometrial Lesions compared with Hysteroscopy in Infertile Women

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1490 ◽

2016 ◽

Vol 10 (4) ◽

pp. 393-397

Author(s):

Firoozeh Ahmadi ◽

Farnaz Akhbari ◽

Fatemeh Niknejad ◽

Hadieh Haghighi ◽

Zahra Ghahremani ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Gold Standard ◽

Three Dimensional ◽

Assessment Method ◽

Diagnostic Efficiency ◽

Infertile Women ◽

Reliable Assessment ◽

Uterine Anomalies

ABSTRACT Introduction Two of the most frequent procedures performed on infertile women are two-dimensional ultrasound (2DUS) and three-dimensional ultrasound (3DUS). Hysteroscopy is considered as the gold standard for evaluation of acquired endometrial lesions in infertile women; however, 3DUS is used as a noninvasive, less expensive, and reliable assessment method for evaluation of the intrauterine lesions in infertile women. We aimed to compare the diagnostic efficiency between 3DUS and hysteroscopy in the detection of lesions (polyps, submucous leiomyoma, and synechiae) in infertile women. Materials and methods In this prospective observational study, infertile women (n = 155) with indication of hysteroscopy were scheduled to undergo 3DUS prior to hysteroscopy from September 2010 to 2011. Women with suspected congenital uterine anomalies were excluded. The sensitivity and specificity values of 3DUS were compared with those of hysteroscopy. Hysteroscopy was used as the gold standard for diagnosis of intrauterine lesions in infertile women. Results Of the 155 women, 50 were found to have an intracavitary abnormality, 36 had polyps, 12 had myomas, and 7 had synechiae on hysteroscopic findings. Examination with 3DUS in the diagnosis of intrauterine lesions reached an accuracy of 94%, and 92.15 and 96.9% of sensitivity and specificity respectively. Positive predictive value (PPV) was 83.9%, and a negative predictive value (NPV) was 91.3% (LR+ = 10.75, LR+ = 0.065). Conclusion According to our results, 3DUS has a reliable diagnostic accuracy for intrauterine lesions, and it may limit unnecessary hysteroscopy in patients with normal results. How to cite this article Ahmadi F, Haghighi H, Ghahremani Z, Niknejad F, Akhbari F, Ramezanali F, Chehrazi M. Diagnostic Accuracy of Three-dimensional Ultrasonography in Detection of Endometrial Lesions compared with Hysteroscopy in Infertile Women. Donald School J Ultrasound Obstet Gynecol 2016;10(4):393-397.

Download Full-text