Prognostic Implication of Diagnostic Confidence Level in Patients with Fibrotic Hypersensitivity Pneumonitis

Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
Jieun Kang ◽  
Yeon Joo Kim ◽  
Jooae Choe ◽  
Eun Jin Chae ◽  
Joon Seon Song ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Confidence Level ◽  
Hypersensitivity Pneumonitis ◽  
Respir Crit ◽  
Diagnostic Algorithm ◽  
Diagnostic Confidence ◽  
Prognostic Implication ◽  
Confidence Levels ◽  
Cox Proportional Hazard ◽  
Cox Analysis

<b><i>Background:</i></b> Hypersensitivity pneumonitis (HP) has various clinical courses and outcomes, but the prognostic factors are not well-defined. Vasakova et al. [Am J Respir Crit Care Med. 2017 Sep;196(6):680–9] have proposed a diagnostic algorithm that categorized suspected patients according to the level of confidence in the diagnosis. This study aimed to investigate whether the confidence level of clinical diagnosis has prognostic implication in patients with fibrotic HP. <b><i>Methods:</i></b> This study included 101 biopsy-proven fibrotic HP patients diagnosed between 2002 and 2017. The patients were retrospectively classified into confident, probable, possible, and unlikely chronic HP, according to the confidence level in the diagnostic criteria/algorithm. The survival and forced vital capacity (FVC) changes were compared between the groups. Risk factors for mortality were analysed using a Cox proportional hazard model. <b><i>Results:</i></b> The median follow-up duration was 67.6 months. The mean age was 60.4 years, and percentages of women were 60.4%. When classified based on the diagnostic criteria/algorithm, possible HP was the most common (51.5%), followed by probable (26.7%), confident (9.9%), and unlikely HP (6.9%). Distinctive survival curves were found according to the diagnostic confidence level, showing the worst outcome in unlikely chronic HP (median survival, 30.2 months). In a multivariable Cox analysis, unlikely HP was a significant predictor of poor survival (hazard ratio, 4.652; 95% confidence interval, 1.231–17.586; <i>p</i> = 0.023), after adjustment for age, body mass index, FVC, and diffusing capacity. <b><i>Conclusions:</i></b> The diagnostic confidence level may predict clinical outcomes in patients with HP. Unlikely HP was shown to have a significantly poorer survival than other diagnostic confidence levels.

scholarly journals Performance of a diagnostic algorithm for fibrotic hypersensitivity pneumonitis. A case–control study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sabina A. Guler ◽  
Eva Wohlfarth ◽  
Sabina Berezowska ◽  
Thomas K. Geiser ◽  
Lukas Ebner ◽  
...  
Keyword(s):  
Confidence Level ◽  
Test Performance ◽  
Hypersensitivity Pneumonitis ◽  
Case Control Study ◽  
Diagnostic Algorithm ◽  
Case Control ◽  
Cox Proportional Hazards ◽  
Diagnostic Process ◽  
Risk Of Death ◽  
Control Study

Abstract Background The differential diagnosis fibrotic hypersensitivity pneumonitis (HP) versus idiopathic pulmonary fibrosis (IPF) is important but challenging. Recent diagnostic guidelines for HP emphasize including multidisciplinary discussion (MDD) in the diagnostic process, however MDD is not comprehensively available. We aimed to establish the diagnostic accuracy and prognostic validity of a previously proposed HP diagnostic algorithm that foregoes MDD. Methods We tested the algorithm in patients with an MDD diagnosis of fibrotic HP or IPF (case control study) and determined diagnostic test performances for diagnostic confidences of ≥ 90% and ≥ 70%. Prognostic validity was established using Cox proportional hazards models. Results Thirty-one patients with fibrotic HP and 50 IPF patients were included. The algorithm-derived ≥ 90% confidence level for HP had high specificity (0.94, 95% confidence interval [CI] 0.83–0.99), but low sensitivity (0.35 [95%CI 0.19–0.55], J-index 0.29). Test performance was improved for the ≥ 70% confidence level (J-index 0.64) with a specificity of 0.90 (95%CI 0.78–0.97), and a sensitivity of 0.74 (95%CI 0.55–0.88). MDD fibrotic HP diagnosis was strongly associated with lower risk of death (adjusted hazard ratio [HR] 0.10 [0.01–0.92], p = 0.04), whereas the algorithm-derived ≥ 70% and ≥ 90% confidence diagnoses were not significantly associated with survival (adjusted HR 0.37 [0.07–1.80], p = 0.22, and adjusted HR 0.41 [0.05–3.25], p = 0.39, respectively). Conclusion The algorithm-derived ≥ 70% diagnostic confidence had satisfactory test performance for MDD-HP diagnosis, with insufficient sensitivity for ≥ 90% confidence. The lowest risk of death in the MDD-derived HP diagnosis validates the reference standard and suggests that a diagnostic algorithm not including MDD, might not replace the latter.

scholarly journals The internship dentists self confidence levels during root canal treatment procedures

2017 ◽  
Vol 5 (2) ◽  
pp. 121
Author(s):  
Mazen Doumani ◽  
Adnan Habib ◽  
Abrar Alhababi ◽  
Ahmad Bashnakli ◽  
Enass Shamsy ◽  
...  
Keyword(s):  
Confidence Level ◽  
Root Canal ◽  
Scoring System ◽  
Dental School ◽  
Root Canal Treatment ◽  
Confidence Levels ◽  
Self Confidence ◽  
Treatment Procedures

Self-confidence level assessment in newly graduated students is very important to evaluate the undergraduate endodontic courses. Objective: The aim of this study was to get information from internship dentists in Alfarabi dental college related to their confidence levels during root canal treatment procedures.Methods: Anonymous survey forms were sent to 150 internship dentists in Alfarbi dental college. They were asked to indicate their self-confidence level by Lickert’s scoring system ranging between 1 and 5.Results: Removal of broken instruments was determined as a procedure that was not experienced by 25.2% of the dentists. (44.6%) of dentists felt confident about taking radiographs during root canal treatment. 1.9 % of them reported as having very little confidence during retreatment. The irrigation was a procedure in which they felt very confident about (59.2%).Conclusion: The non-practiced endodontic procedure was clearly related to levels of self confidence among internship dentists; this means; a lot of studies in dental school should be performed to determine the weakness points or gaps in undergraduate endodontic courses.

Clinical features of chronic summer-type hypersensitivity pneumonitis and proposition of diagnostic criteria

2020 ◽  
Vol 58 (1) ◽  
pp. 59-67
Author(s):  
Yasutaka Onishi ◽  
Tetsuji Kawamura ◽  
Takanori Higashino ◽  
Ryogo Kagami ◽  
Nobuya Hirata ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Clinical Features ◽  
Hypersensitivity Pneumonitis

A proposal of a diagnostic algorithm with validation of International Consensus Diagnostic Criteria for autoimmune pancreatitis in a Japanese cohort

Pancreatology ◽  
2013 ◽  
Vol 13 (3) ◽  
pp. 230-237 ◽  
Author(s):  
Kimi Sumimoto ◽  
Kazushige Uchida ◽  
Toshiyuki Mitsuyama ◽  
Yuri Fukui ◽  
Takeo Kusuda ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Autoimmune Pancreatitis ◽  
Diagnostic Algorithm ◽  
International Consensus ◽  
Japanese Cohort

On the application of confidence limits to biostratigraphy: an example from diatoms

2020 ◽  
Author(s):  
Cristina Lopes ◽  
João Velez
Keyword(s):  
Sedimentation Rate ◽  
Confidence Level ◽  
Confidence Limits ◽  
Confidence Levels ◽  
Expedition 346 ◽  
Age Model

&lt;p&gt;For years, diatom-based biostratigraphy has been settings bio-events based on a qualitatively approach. This means that the biostratigraphy would set an age based on the findings or not of a certain species. However, how many species are needed to consider a certain datum as certain? One, ten, 100? Moreover, each biostratigrapher sets its on limits. One might consider one as enough and another 10. Therefore, the scale more often used is the absent, rare, frequent, common, dominant or abundant with an explanation of what of these definitions mean. This is very common in, for example, IODP expeditions.&lt;/p&gt;&lt;p&gt;However, what would happen to these biostratigraphy levels if one would apply, for example, a concept of 95% confidence level? Moreover, what would happen to an age model if this concept would be applied to all the biostratigraphy microfossil?&lt;/p&gt;&lt;p&gt;Here we will show Expedition 346 age model differences with and without confidence levels applied to diatoms. The differences can be significant and even considering the existence of a hiatus can be reconsider if confidence limits are applied, turning a possible hiatus into a very slow sedimentation rate having serious implications to the initial paleoceanographic interpretations.&lt;/p&gt;

On Determination of Sample Size to Evaluate Reliability Growth Plans

2011 ◽  
Author(s):  
X. Jin ◽  
P. Woytowitz ◽  
T. Tan
Keyword(s):  
Sample Size ◽  
Confidence Level ◽  
Semiconductor Manufacturing ◽  
Field Performance ◽  
Reliability Growth ◽  
Confidence Levels ◽  
Equipment Reliability ◽  
Margin Of Error ◽  
Reliability Performance

The reliability performance of Semiconductor Manufacturing Equipments (SME) is very important for both equipment manufacturers and customers. However, the response variables are random in nature and can significantly change due to many factors. In order to track the equipment reliability performance with certain confidence, this paper proposes an efficient methodology to calculate the number of samples needed to measure the reliability performance of the SME tools. This paper presents a frequency-based Statistics methodology to calculate the number of sampled tools to evaluate the SME reliability field performance based on certain confidence levels and error margins. One example case has been investigated to demonstrate the method. We demonstrate that the multiple weeks accumulated average reliability metrics of multiple tools do not equal the average of the multiple weeks accumulated average reliability metrics of these tools. We show how the number of required sampled tools increases when the reliability performance is improved and quantify the larger number of sampled tools required when a tighter margin of error or higher confidence level is needed.

scholarly journals Study on the Confidence and Reliability of the Mean Seismic Probability Risk Model

2017 ◽  
Vol 2017 ◽  
pp. 1-9
Author(s):  
Xiao-Lei Wang ◽  
Da-Gang Lu
Keyword(s):  
Seismic Design ◽  
Confidence Level ◽  
Risk Model ◽  
Safety Evaluation ◽  
Design Parameters ◽  
Critical Infrastructures ◽  
High Confidence ◽  
Confidence Levels ◽  
The Mean ◽  
Mean Risk

The mean seismic probability risk model has widely been used in seismic design and safety evaluation of critical infrastructures. In this paper, the confidence levels analysis and error equations derivation of the mean seismic probability risk model are conducted. It has been found that the confidence levels and error values of the mean seismic probability risk model are changed for different sites and that the confidence levels are low and the error values are large for most sites. Meanwhile, the confidence levels of ASCE/SEI 43-05 design parameters are analyzed and the error equation of achieved performance probabilities based on ASCE/SEI 43-05 is also obtained. It is found that the confidence levels for design results obtained using ASCE/SEI 43-05 criteria are not high, which are less than 95%, while the high confidence level of the uniform risk could not be achieved using ASCE/SEI 43-05 criteria and the error values between risk model with target confidence level and mean risk model using ASCE/SEI 43-05 criteria are large for some sites. It is suggested that the seismic risk model considering high confidence levels instead of the mean seismic probability risk model should be used in the future.

scholarly journals An analytical method of estimating Value-at-Risk on the Belgrade Stock Exchange

2009 ◽  
Vol 54 (183) ◽  
pp. 119-138 ◽  
Author(s):  
Milica Obadovic ◽  
Mirjana Obadovic
Keyword(s):  
At Risk ◽  
Failure Rate ◽  
Confidence Level ◽  
Analytical Method ◽  
Value At Risk ◽  
Risk Evaluation ◽  
Risk Model ◽  
Stock Exchange ◽  
Confidence Levels ◽  
The Given

This paper presents market risk evaluation for a portfolio consisting of shares that are continuously traded on the Belgrade Stock Exchange, by applying the Value-at-Risk model - the analytical method. It describes the manner of analytical method application and compares the results obtained by implementing this method at different confidence levels. Method verification was carried out on the basis of the failure rate that demonstrated the confidence level for which this method was acceptable in view of the given conditions.

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