THUR 071 Towards an integrated tool for pnes assessment

2018 ◽  
Vol 89 (10) ◽  
pp. A8.2-A8
Author(s):  
d’Ersu Eleanor ◽  
Al-Mayhani Talal ◽  
Sidhu Meneka
Keyword(s):  
Clinical Practice ◽  
Conversation Analysis ◽  
Gold Standard ◽  
Reliability And Validity ◽  
Epileptic Seizures ◽  
List Type ◽  
Clinical Tool ◽  
Medical Assessment ◽  
Diagnostic Challenge ◽  
Autonomic Activation

IntroductionPsychogenic non-epileptic seizures (PNES) can present a real diagnostic challenge, with subsequent impact on the course of the disorder and its management. A number of studies have looked into predictive factors for PNES. However, no guidance is available for applying the findings of these studies in clinical practice.AimThe aim is to combine the most recognised discriminative features into an integrated clinical tool, ultimately, to improve the predictive value of the medical assessment of patients with possible PNES in a clinic setting. This can be invaluable in centres with limited access to video telemetry (VT).MethodsThe following criteria were employed and compared with the results of VT as gold standard:Patient comorbiditiesConversation analysisReview of system questionnaireIctal semiology and autonomic activationPostictal prolactin and lactateResults and conclusionThis QIP will assess the reliability and validity of various criteria in recognising PNES clinically. Based on our findings, an integrated tool will then be designed as an adjunct to the standard medical assessment in settings where VT is not readily available.

Reliability and Concurrent Validity of Shoulder Tissue Irritability Classification

2021 ◽  
Author(s):  
Stephen M Kareha ◽  
Philip W McClure ◽  
Alicia Fernandez-Fernandez
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Repeated Measures ◽  
Concurrent Validity ◽  
Reliability And Validity ◽  
Strong Relationship ◽  
Rating System ◽  
Roc Curve Analysis ◽  
Cross Sectional

Abstract Objective Rating tissue irritability has been recommended to aid decision making in several recent clinical practice guidelines. An explicit method for rating tissue irritability was proposed as part of the Staged Algorithm for Rehabilitation Classification: Shoulder Disorders (STAR-Shoulder), but the reliability and validity of this classification are unknown. The purpose of this study was to examine the reliability and concurrent validity of shoulder tissue irritability ratings as part of a system designed to guide appropriate treatment strategy and intensity. Methods A clinical measurement, prospective repeated-measures cross-sectional design was used. The 101 consecutive participants with primary complaints of shoulder pain were assessed by pairs of blinded raters (24 raters in total) and rated for tissue irritability. Patients completed 3 patient-rated outcome (PRO) measures reflecting both pain and disability, and these scores were compared with ratings of tissue irritability. Paired ratings of irritability were analyzed for reliability with prevalence-adjusted, bias-adjusted Kappa for ordinal scales (PABAK-OS). Analysis of variance (ANOVA) was used to compare PRO measures across different levels of irritability. Receiver operating characteristic (ROC) curve analysis was utilized to derive cut-off scores for 3 PRO instruments. Results Interrater reliability was 0.69 (95% CI = 0.59–0.78), with 67% agreement. All PRO measures were significantly different among 3 levels of tissue irritability. Conclusion There appear to be acceptable reliability and a strong relationship between PRO measures and therapist-rated tissue irritability, supporting the use of the STAR-Shoulder irritability rating system. Impact Several clinical practice guidelines have recommended that clinicians rate tissue irritability as part of their examination. This study provides important new information supporting the reliability and validity of the STAR-Shoulder tissue irritability rating system.

scholarly journals The Infinity Formulation: how transdiagnostic behaviours and endeavours for behavioural change serve to maintain co-morbid mental health presentations

2021 ◽  
Vol 14 ◽  
Author(s):  
Alison Bennetts
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Cognitive Biases ◽  
Behavioural Change ◽  
Psychological Theory ◽  
Primary Treatment ◽  
Future Research ◽  
List Type ◽  
Cognitive Behavioural ◽  
Co Morbidity

Abstract Treatment recommendations for mental health are often founded on diagnosis-specific models; however, there are high rates of co-morbidity of mental health presentations and growing recognition of the presence of ‘transdiagnostic processes’ (cognitive, emotional or behavioural features) seen across a range of mental health presentations. This model proposes a novel conceptualisation of how transdiagnostic behaviours may maintain co-morbid mental health presentations by acting as a trigger event for the cognitive biases specific to each presentation. Drawing on existing evidence, psychological theory and the author’s clinical experience, the model organises complex presentations in a theory-driven yet accessible manner for use in clinical practice. The model offers both theoretical and clinical implications for the treatment of mental health presentations using cognitive behavioural approaches, positing that transdiagnostic behaviours be the primary treatment target in co-morbid presentations. Key learning aims (1) To understand the strengths and limitations of existing transdiagnostic CBT formulation models. (2) To learn about a novel, transdiagnostic and behaviourally focused formulation for use in clinical practice. (3) To understand how to use the tool in clinical practice and future research.

A comparison of the ‘Hamilton Rating Scale for Depression’ and the ‘Montgomery-Asberg Depression rating Scale’

1999 ◽  
Vol 11 (1) ◽  
pp. 34-37 ◽  
Author(s):  
I.P.A.M. Huijbrechts ◽  
P.M.J. Haffmans ◽  
K. Jonker ◽  
A. van Dijke ◽  
E. Hoencamp
Keyword(s):  
Clinical Practice ◽  
Clinical Global Impression ◽  
Rating Scale ◽  
Reliability And Validity ◽  
Structured Interview ◽  
Clinical Impression ◽  
Clinical Relationship ◽  
Hamilton Rating Scale ◽  
Depressive States

SummaryAlthough the Hamilton Rating Scale for Depression (HRSD) is the most frequently used rating scale for quantifying depressive states, it has been criticized for its reliability and its usability in clinical practice. This criticism is less applying to the Montgomery-Asberg Depression Rating Scale (MADRS). Goal of the present study is to investigate the reliability and validity, and clinical relationship between the HRSD and the MADRS. For 60 out-patients with diagnosed depression (DSM IV296.2x, 296.3x, 300.40 and 311.00), the HRSD and MADRS were scored at baseline and 6 weeks later by an independent rater according to a structured interview. Also the Clinical Global Impression (CGI) was assessed by a psychiatrist. Satisfying agreement was found between the totalscores (r= .75, p>.000 en r=.92, p>.000 respectively, at baseline and 6 weeks later). Furthermore agreement was found between the items of both scales, and these agree with the clinical impression. The reliability of the MADRS is more stable than the reliability of the HRSD (α = .6367 and α =.8900 vs α = .2193 and α = .8362 at baseline and at endpoint respectively). Considering the ease of scoring both scales in one interview and the widely international use of the HRSD, scoring both the HRSD and the MADRS to measure the severity of a depression seems to be an acceptabel covenant.

Trends in randomized controlled trials in ENT: a 30-year review

1997 ◽  
Vol 111 (7) ◽  
pp. 611-613 ◽  
Author(s):  
K. W. Ah-See ◽  
N. C. Molony ◽  
A. G. D. Maran
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Randomized Controlled Trials ◽  
Gold Standard ◽  
Controlled Trials ◽  
Evidence Based ◽  
Controlled Clinical Trials ◽  
Medline Search ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled

AbstractThere is a growth in the demand for clinical practice to be evidence based. Recent years have seen a rise in the number of randomized controlled clinical trials (RCTS). Such trials while acknowledged as the gold standard for evidence can be difficult to perform in surgical specialities. We have recently identified a low proportion of RCTS in the otolaryngology literature. Our aim was to identify any trend in the number of published RCTS within the ENT literature over a 30-year period and to identify which areas of our speciality lend themselves to this form of study design. A Medline search of 10 prominent journals published between 1966 and 1995 was performed. Two hundred and ninety-six RCTS were identified. Only five were published before 1980. Two hundred (71 per cent) of RCTS were in the areas of otology and rhinology. An encouraging trend is seen in RCTS within ENT literature.

scholarly journals Reliability and Validity of Composite Scores from the NIH Toolbox Cognition Battery in Adults

2014 ◽  
Vol 20 (6) ◽  
pp. 588-598 ◽  
Author(s):  
Robert K. Heaton ◽  
Natacha Akshoomoff ◽  
David Tulsky ◽  
Dan Mungas ◽  
Sandra Weintraub ◽  
...  
Keyword(s):  
Cognitive Abilities ◽  
Gold Standard ◽  
Reliability And Validity ◽  
Epidemiologic Studies ◽  
Memory Processing ◽  
Significant Relationships ◽  
Gender Education ◽  
Computer Based ◽  
Composite Scores ◽  
Test Retest Reliability

AbstractThis study describes psychometric properties of the NIH Toolbox Cognition Battery (NIHTB-CB) Composite Scores in an adult sample. The NIHTB-CB was designed for use in epidemiologic studies and clinical trials for ages 3 to 85. A total of 268 self-described healthy adults were recruited at four university-based sites, using stratified sampling guidelines to target demographic variability for age (20–85 years), gender, education, and ethnicity. The NIHTB-CB contains seven computer-based instruments assessing five cognitive sub-domains: Language, Executive Function, Episodic Memory, Processing Speed, and Working Memory. Participants completed the NIHTB-CB, corresponding gold standard validation measures selected to tap the same cognitive abilities, and sociodemographic questionnaires. Three Composite Scores were derived for both the NIHTB-CB and gold standard batteries: “Crystallized Cognition Composite,” “Fluid Cognition Composite,” and “Total Cognition Composite” scores. NIHTB Composite Scores showed acceptable internal consistency (Cronbach’s alphas=0.84 Crystallized, 0.83 Fluid, 0.77 Total), excellent test–retest reliability (r: 0.86–0.92), strong convergent (r: 0.78–0.90) and discriminant (r: 0.19–0.39) validities versus gold standard composites, and expected age effects (r=0.18 crystallized, r=−0.68 fluid, r=−0.26 total). Significant relationships with self-reported prior school difficulties and current health status, employment, and presence of a disability provided evidence of external validity. The NIH Toolbox Cognition Battery Composite Scores have excellent reliability and validity, suggesting they can be used effectively in epidemiologic and clinical studies. (JINS, 2014, 20, 1–11)

scholarly journals Cardiac Outpouchings: Definitions, Differential Diagnosis, and Therapeutic Approach

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Riccardo Scagliola ◽  
Gian Marco Rosa ◽  
Sara Seitun
Keyword(s):  
Differential Diagnosis ◽  
Clinical Practice ◽  
Therapeutic Approach ◽  
Tissue Characterization ◽  
Case Reports ◽  
Case Series ◽  
Diagnostic Challenge ◽  
Comprehensive Overview ◽  
Search Data ◽  
Data Location

Background and Aims. Cardiac outpouchings encounter a series of distinct congenital or acquired entities (i.e. aneurysms, pseudoaneurysms, diverticula, and herniations), whose knowledge is still poorly widespread in clinical practice. This review aims to provide a comprehensive overview focusing on definition, differential diagnosis, and prognostic outcomes of cardiac outpouchings, as well as further insights on therapeutic options, in order to assist physicians in the most appropriate decision-making. Methods. The material reviewed was obtained by the following search engines: MEDLINE (PubMed), EMBASE, Google Scholar, and Clinical Trials databases, from January 1966 until March 2021. We searched for the following keywords (in title and/or abstract): (“cardiac” OR “heart”) AND (“outpouching” OR “outpouch” OR “aneurysm” OR “pseudoaneurysm” OR “false aneurysm” OR “diverticulum” OR “herniation”). Review articles, original articles, case series, and case reports with literature review were included in our search. Data from patients with congenital or acquired cardiac outpouchings, from prenatal to geriatric age range, were investigated. Results. Out of the 378 papers initially retrieved, 165 duplicates and 84 records in languages other than English were removed. Among the 129 remaining articles, 76 were included in our research material, on the basis of the following inclusion criteria: (a) papers pertaining to the research topic; (b) peer-reviewed articles; (c) using standardized diagnostic criteria; and (d) reporting raw prevalence data. Location, morphologic features, wall motion abnormalities, and tissue characterization were found to have a significant impact in recognition and differential diagnosis of cardiac outpouchings as well as to play a significant role in defining their natural history and prognostic outcomes. Conclusions. Careful recognition of cardiac outpouchings remains a diagnostic challenge in clinical practice. Due to a broad cluster of distinctive and heterogeneous entities, their knowledge and timely recognition play a pivotal role in order to provide the most appropriate clinical management and therapeutic approach.

scholarly journals EXTERNAL VALIDATION OF THE IMPROVING PARTIAL RISK ADJUSTMENT IN SURGERY (PRAIS2) MODEL FOR 30-DAY MORTALITY AFTER PEDIATRIC CARDIAC SURGERY

2020 ◽  
Author(s):  
Lucia Cocomello ◽  
Massimo Caputo ◽  
Rosie Cornish ◽  
Deborah A. Lawlor
Keyword(s):  
Cardiac Surgery ◽  
Clinical Practice ◽  
Risk Adjustment ◽  
Heart Surgery ◽  
Risk Model ◽  
External Validation ◽  
Risk Function ◽  
P Value ◽  
List Type ◽  
Single Centre

ABSTRACTObjectiveRisk stratification in paediatric patients undergoing heart surgery remains a challenge. The improving partial risk adjustment in surgery (PRAIS2) is a risk model predicting 30-day mortality which has been recently developed and validated using a UK-based cohort from April 2009-March 2015. We aimed to perform an independent temporal external validation to explore its generalisability and clinical utility.MethodsPRAIS2 validation was carried out using a single centre (Bristol, UK) cohort from April 2004 to March 2009 and April 2015 to July 2019. For each subject PRAIS2 score was calculated according to the original formula. PRAIS2 performance was assessed in terms of discrimination by means of ROC curve analysis and calibration by using the calibration belt method.ResultsA total of 1330 (2004-2009) and 1187 (2015-2019) paediatric cardiac surgical procedures were included in the first and second independent validation, respectively (median age at the procedure 6.0 and 6.9 months). PRAIS2 score showed excellent discrimination for both independent validations (AUC 0.72 (95%CI: 0.65 to 0.80) and 0.87 (95%CI: 0.82 to 0.93), respectively). While PRAIS2 was only marginally calibrated in the first validation, with a tendency to underestimate risk P-value = 0.051), the second validation showed good calibration with 95% confidence belt containing the bisector for predicted mortality (P-value = 0.15); We also observed good performance in the subgroup of patients undergoing non-elective procedures (N = 482; AUC 0.78 (95%CI 0.68 to 0.87); Calibration belt containing the bisector (P-value=0.61).ConclusionsIn a single centre UK-based cohort, PRAIS2 showed excellent discrimination and calibration in predicting 30-day mortality in paediatric cardiac surgery including in those undergoing non-elective procedures. Our results support a wider adoption of PRAIS2 score in the clinical practice.Strengths and limitations of this studyA strength of the present study is that data were prospectively collected as part of the UK National Congenital Heart Disease Audit and as such they undergo continuous and inclusive systematic validation that includes the review of a sample of case notes by external auditors to ensure coding accuracy.We used a recently proposed method (calibration belt) which does not require patients to be categorised according to risk percentile but rather provides a risk function across all risk value with relative uncertainty measure (95% CI)A key limitation of this study is that the sample size is relatively small and considerably smaller than the cohort used to develop PRAIS2Key questionsWhat is already known about this subject? The improving partial risk adjustment in surgery (PRAIS2) is a risk model predicting 30-day mortality which has been recently developed and validated using a UK-wide cohort.What does this study add? The present study reported the first independent external validation of the PRAIS2 using a single centre cohort which confirmed excellent performance of the model and for the first time showed that it also accurately predicts mortality in patients undergoing non-elective proceduresHow might this impact on clinical practice? Our results support a wider adoption of the PRAIS2 in the clinical practice.

scholarly journals DYSKIMOT: An ultra-low-cost inertial sensor to assess head’s rotational kinematics in adults during the Didren-Laser Test

2019 ◽  
Author(s):  
Renaud Hage ◽  
Christine Detrembleur ◽  
Frédéric Dierick ◽  
Laurent Pitance ◽  
Laurent Jojczyk ◽  
...  
Keyword(s):  
Time Series ◽  
Clinical Practice ◽  
Gold Standard ◽  
Inertial Sensor ◽  
Low Cost ◽  
Real Life ◽  
Optoelectronic System ◽  
Qualitative Level ◽  
Cervical Motion ◽  
Head Rotations

Various noninvasive measurement devices can be used to assess cervical motion. Size, complexity and cost of gold-standard systems make them not suited in clinical practice, and actually difficult to use outside dedicated laboratory. Nowadays, ultra-low-cost inertial measurement units are available but without any packaging nor user-friendly interface. DYSKIMOT is a home- designed, small-sized, motion sensor based on the latter technology, aiming at being used by clinicians in “real-life situations”. In the present study. DYSKIMOT was compared with a gold- standard optoelectronic system (Elite). Our goal was to evaluate the accuracy of DYSKIMOT in assessing the kinematics in fast head rotations. Kinematics was simultaneously recorded by the DYSKIMOT and Elite systems during the execution of the DidRen Laser test and performed by 15 participants and 9 patients. Kinematic variables were computed from the position, speed and acceleration time series. Two-way ANOVA, Passing-Bablok regressions and Dynamic Time Warping analysis showed good to excellent agreement between Elite and DYSKIMOT, both at the qualitative level of the time series shape and at the quantitative level of peculiar kinematical events’ measured values. In conclusion, DYSKIMOT sensor is as relevant as a gold-standard system to assess kinematical features during fast head rotations in participants and patients, demonstrating its usefulness in clinical practice or research in ecological environment.

scholarly journals Burnout in dental students: effectiveness of different methods

2013 ◽  
Vol 42 (5) ◽  
pp. 324-329 ◽  
Author(s):  
Juliana Alvares Duarte Bonini Campos ◽  
Paula Cristina Jordani ◽  
Miriane Lucindo Zucoloto ◽  
Fernanda Salloume Sampaio Bonafé ◽  
João Maroco
Keyword(s):  
Undergraduate Students ◽  
Gold Standard ◽  
Reliability And Validity ◽  
Roc Curves ◽  
Maslach Burnout Inventory ◽  
Dental Students ◽  
Burnout Syndrome ◽  
Screening Methods ◽  
Student Survey ◽  
Adequate Reliability

OBJECTIVE: This study was proposed to estimate the effectiveness of different screening methods of the Burnout Syndrome among dental students. MATERIAL AND METHOD: The Burnout Syndrome assessment was performed using the Oldenburg Inventory-Student survey (OLBI-SS) and the Copenhagen Inventory-Student survey (CBI‑SS). The Maslach Burnout Inventory-Student survey (MBI-SS) was used as the gold standard. The psychometric properties of the instruments were measured. The second-order hierarchical model was estimated to calculate the overall scores for OLBI-SS and CBI-SS, and ROC curves were constructed and the areas were estimated (AUROC). RESULT: A total of 235 undergraduate students participated in this study. The instruments showed an adequate reliability and validity; however three questions had to be removed from OLBI-SS and one from CBI-SS. The Exhaustion dimension of OLBI-SS, and Personal Burnout and Study related Burnout of CBI-SS presented a good discriminating capacity. CONCLUSION: CBI-SS showed higher discriminating capacity, than OLBI-SS, to identify the Burnout Syndrome (DAUROC=.172 [.103-.240]; p<.05).

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