Abstract P402: A Rapid Automated Method Detects Probable Errors Among Sequential Clinical Measures Recorded During Clinical Care

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Dawn C Schwenke
Keyword(s):  
Extreme Values ◽  
Clinical Care ◽  
New Method ◽  
Individual Values ◽  
Cut Points ◽  
Automated Method ◽  
Blood Pressures ◽  
The Mean ◽  
Va Health Care System ◽  
Clinical Measures

Information collected during clinical care is increasingly used for research. Such data include errors and a rapid automated method for identifying likely errors is needed. This study aimed to develop a rapid automated method for identifying extreme values among sequential measures recorded during clinical care and to compare this method with the extreme studentized deviate many outlier procedure (ESD). Data were weights (W, n=1,151,434), heights (H, n=760,924), pulses (P, n=1,369,484), and systolic (S, n=1,680,583) and diastolic (D, n=1,680,503) blood pressures for 88,068 Veterans (82,874 men and 5,194 women) receiving care from the Phoenix VA Health Care System who had ≥5 five sequential values for these measures recorded in the electronic medical record during primary care visits from October 1999- September 2013. The new method identified extreme values by comparing individual values with three within-person metrics: 1. median (PMed), 2. interquartile range (PIQR), and 3. modified IQR [ModPIQR: PMed + / - smaller of (PMed - 25th percentile) and (75th percentile - PMed)]. These measures were selected because they were expected to be less perturbed by extreme values than the mean and standard deviation. Values exceeding cut-points (> 99th or < 1st population percentile) for ≥ 2 metrics were considered errors. High errors (0.46% W, 0.40% H, 0.55% P, 0.48% S, 0.50% D) were median 125%, 107%, 156%, 135% and 140% of PMed; median 3.3, 2.3, 2.8, 2.0 and 2.1 fold above PIQR; and median 5.0, 20, 3.4, 2.6, and 2.6 fold above ModPIQR for W, H, P, S, and D, respectively. Low errors (0.48% W, 0.43% H, 0.48% P, 0.46% S, 0.47% D) were 73%, 86%, 62%, 70%, and 65% of PMed; median 4.3, 5.0, 2.0, 1.8, and 2.1 fold below PIQR; and median 6.4, 50, 2.6, 2.3, and 2.4 fold below ModPIQR for W, H, P, S, and D. Compared with the new method, ESD (alpha = 0.01) identified fewer total (high+low) outliers for D (0.21% vs. 0.97%), P (0.58% vs. 1.03%), and S (0.14% vs. 0.94%), more outliers for H (2.40% vs. 0.83%), and similar numbers for W (0.70% vs. 0.94%). Both high (> 99th population percentile) and low (< 1st population percentile) extreme values for percent of PMed were detected with greater sensitivity by the new method (39%, 39%, 50%, 45%, and 46%; 41%, 40%, 43%, 41%, and 42%, respectively for high and low extremes for W, H, P, S, D) than by ESD (19%, 20%, 22%, 6%, 9% and 27%, 31%, 11%, 3%, 7%, respectively) while specificity was equally high (>98%) for both methods. The new method can be easily implemented and effectively identifies extreme values likely to be errors from among sequential clinical measures and could help reveal underlying longitudinal trends in weight/BMI, blood pressure or other clinical measures.

Pre-operative Plasma Levels of Thrombin-Antithrombin III Complexes Correlate with the Development of Venous Thrombosis after Major Hip or Knee Surgery

1995 ◽  
Vol 74 (02) ◽  
pp. 602-605 ◽  
Author(s):  
Jeffrey S Ginsberg ◽  
Patrick Brill-Edwards ◽  
Akbar Panju ◽  
Ameen Patel ◽  
Joanne McGinnis ◽  
...  
Keyword(s):  
Antithrombin Iii ◽  
Tertiary Care ◽  
Knee Surgery ◽  
Referral Centre ◽  
Study Objective ◽  
Cut Points ◽  
Vein Thrombosis ◽  
Major Orthopedic Surgery ◽  
The Mean ◽  
Deep Vein

SummaryStudy objective. To determine whether levels of thrombin-antithrombin III (TAT) in plasma, taken two weeks pre-operatively, predict the development of deep vein thrombosis (DVT) in patients undergoing major hip or knee surgery.Design. Prospective cohort.Setting. Tertiary-care referral centre, university-affiliated hospital.Patients. Ninety eight consecutive patients undergoing elective hip or knee surgery.Intervention. All eligible consenting patients were seen in a preoperative clinic two weeks prior to surgery and had blood taken for measurement of plasma TAT level. After surgery, they received a combination of unfractionated heparin 5000 Units 12-hourly subcutaneously, and antiembolism stockings (TEDS), as prophylaxis against DVT. Contrast venography was performed prior to discharge, and according to the results, patients were classified as having proximal (popliteal and/or more proximal) DVT (n = 12), calf DVT (n = 7) or no DVT (n = 79).Measurements and Results. The mean TAT level was significantly higher in patients who developed DVT (5.7 μg/l) than in those who did not (4.1 μg/l), p = 0.035. Using cut-points of 3.5 and 5.5 μg/l for the TAT level, patients could be categorized as high, intermediate, and low risk for the development of DVT. The proportion of patients with TAT levels of ≥3.5μg/l who developed calf or proximal DVT was significantly higher than the proportion of patients with TAT levels of <3.5 μg/l who developed calf or proximal DVT (p = 0.02). The proportion of patients with TAT levels >5.5 μg/l who developed proximal DVT was significantly higher than the proportion of patients with TAT levels of ≤5.5 μg/l who developed proximal DVT (p = 0.03).Conclusions. This study demonstrates that pre-operative TAT levels correlate with the risk of developing DVT after major orthopedic surgery. Further studies are needed to determine the reason(s) for this observation and whether rational recommendations about prophylaxis and screening for DVT can be made based on the results of a pre-operative TAT level.

Quality of Life for Children with Persistent Sinonasal Symptoms

2003 ◽  
Vol 128 (1) ◽  
pp. 17-26 ◽  
Author(s):  
David J. Kay ◽  
Richard M. Rosenfeld
Keyword(s):  
Quality Of Life ◽  
Clinical Care ◽  
Longitudinal Change ◽  
Good Test ◽  
Routine Clinical Care ◽  
Before And After ◽  
The Mean ◽  
The Individual ◽  
Sinonasal Symptoms

OBJECTIVE: The goal was to validate the SN-5 survey as a measure of longitudinal change in health-related quality of life (HRQoL) for children with persistent sinonasal symptoms. DESIGN AND SETTING: We conducted a before and after study of 85 children aged 2 to 12 years in a metropolitan pediatric otolaryngology practice. Caregivers completed the SN-5 survey at entry and at least 4 weeks later. The survey included 5 symptom-cluster items covering the domains of sinus infection, nasal obstruction, allergy symptoms, emotional distress, and activity limitations. RESULTS: Good test-retest reliability ( R = 0.70) was obtained for the overall SN-5 score and the individual survey items ( R ≥ 0.58). The mean baseline SN-5 score was 3.8 (SD, 1.0) of a maximum of 7.0, with higher scores indicating poorer HRQoL. All SN-5 items had adequate correlation ( R ≥ 0.36) with external constructs. The mean change in SN-5 score after routine clinical care was 0.88 (SD, 1.19) with an effect size of 0.74 indicating good responsiveness to longitudinal change. The change scores correlated appropriately with changes in related external constructs ( R ≥ 0.42). CONCLUSIONS: The SN-5 is a valid, reliable, and responsive measure of HRQoL for children with persistent sinonasal symptoms, suitable for use in outcomes studies and routine clinical care.

scholarly journals O15 Using a smartphone app to characterise and quantify skin colour changes in Raynaud's attacks

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Graham Dinsdale ◽  
Joanne Manning ◽  
Ariane Herrick ◽  
Mark Dickinson ◽  
Christopher Taylor
Keyword(s):  
Mobile Phone ◽  
Strong Association ◽  
Colour Change ◽  
Objective Measure ◽  
Skin Colour ◽  
Smartphone App ◽  
Limiting Factor ◽  
Bhattacharyya Distance ◽  
Automated Method ◽  
The Mean

Abstract Background/Aims  The lack of objective outcome measures for Raynaud's phenomenon (RP) has been a major limiting factor in development of effective treatments. At present, the Raynaud's Condition Score (RCS) is the only validated outcome measure, and is highly subjective. Mobile phone technology could provide a way forward. We have developed a smartphone app for RP monitoring that guides the patient through the process of capturing images of their hands during RP episodes, as well as capturing other data through post-attack and daily questionnaires. One of the objectives of our research programme (reported here) was to compare digital image (photographic) parameters to the RCS. Methods  40 patients with RP (8 with primary RP, 32 with RP secondary to systemic sclerosis) were recruited (40 female, median age (range): 57 years (25-74), median (range) duration of RP symptoms: 17 (0-53) years). Patients were given a smartphone handset with a pre-installed Raynaud’s Monitoring app and were trained on how to use it/take usable photographs. They were then asked to take photographs of RP attacks over a 14 day period and also to record the RCS for each episode. The app specifically prompts the patient to take a picture of their hand every minute during an attack, until confirmation is given that the attack is complete. At a 2nd visit, the handsets, images, and data were collected for analysis. The mean colour change during each RP attack was quantified (semi-automated method) by the Bhattacharyya distance (BD) in colour space between a region of interest (e.g. a section of a digit) and a control region (dorsal hand). BD was then compared to the RCS using ANOVA, after controlling for patient variability in the range of RCS values used by each patient. Results  A total of 3,030 images were collected, describing 229 RP attacks. The median RCS reported was 6 (inter-quartile range [IQR]: 4), while the median for BD was 5.6 (IQR 3.2). ANOVA showed that measured values of the mean image BD were significantly different when different values of RCS were recorded by the patient (p &lt; 0.001), i.e. attacks where patients selected different values of RCS had significantly different values of BD. Across all attacks/patients the F-value from ANOVA for RCS was 76.2, suggesting that the variation in BD for different values of RCS is much greater than the variation in BD for any one value of RCS. Conclusion  Patients successfully used a smartphone app to collect photographs and data during episodes of RP. A strong association was found between skin colour change (via BD) and the gold-standard RCS. Mobile phone-documented colour change therefore has potential as an objective measure of RP. Further validation work is now required, as well as studies examining sensitivity to change. Disclosure  G. Dinsdale: None. J. Manning: None. A. Herrick: None. M. Dickinson: None. C. Taylor: None.

scholarly journals On some continuous observations of the rate of dissipation of electric charges in the open air

1905 ◽  
Vol 76 (508) ◽  
pp. 152-159 ◽  
Keyword(s):  
New Zealand ◽  
Individual Values ◽  
Similar Work ◽  
Maximum Value ◽  
Variable Quantity ◽  
The Mean ◽  
Atmospheric Conductivity ◽  
Rate Of Dissipation ◽  
The Individual ◽  
Sea Coast

During the latter part of 1902 and the early months of 1903 I resolved to take as many observations of the rates of dissipation of positive and negative electric charges as possible, and to continue them over the whole 24 hours of the day, and, when opportunity offered, over longer periods. There appeared to be little information regarding the rate of dispersion during the night hours. At about the same time that these observations were being made, Nilsson was doing similar work at Upsala, and found a noticeable maximum value for atmospheric conductivity at about midnight. The observations were made on the Canterbury Plains of New Zealand, at a station about 20 feet above sea-level and about five miles due west from the sea coast. The apparatus used was Elster and Geitel’s Zerstreuungs- apparat , and the formula of reduction used was that given by them, viz:- E = 1/ t log V 0 /V- n / t ' log V' 0 /V' . In this formula E is proportional to the conductivity of the gas surrounding the instrument—for positive or negative charges, as the case may be. The constant “ n ” = ratio of capacity without cylinder ____________________________________ capacity with cylinder was determined by me to be 0·47, as the instrument was always used, with the protecting cover. The cover was always at one height above the base of the instrument, and was set so as to be as nearly co-axial with the discharging cylinder as could be judged by eye. No attempt was made to determine the actual capacity of the condenser cylinder and protecting cover, which would be a somewhat variable quantity owing- (1) to the differences on different days in attempting to cause the two to be co-axial; (2) to a certain amount of looseness in the fit of the shank of the cylinder on to its hole. The value above given for “ n "is the mean of several deter­minations made with different settings of the cover and cylinder. The individual values of “ n ” varied over about 0.03.

Abstract P606: Hemodynamic Predictors of Multiple Recurrent Strokes in the Patients With Prior Lacunar Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Alexandra Kvernland ◽  
Alen Delic ◽  
Ka-ho Wong ◽  
Nazanin Sheibani ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Failure Time ◽  
Recurrent Stroke ◽  
Cox Proportional Hazards Model ◽  
Lacunar Stroke ◽  
Blood Pressures ◽  
Recurrent Strokes ◽  
The Mean

Background: Recurrent stroke has higher morbidity and mortality than incident stroke. We evaluated hemodynamic risk factors for multiple recurrent strokes. Methods: We included patients in the SPS3 trial. The primary predictor was the top tertile, compared to the bottom tertile, of the mean systolic blood pressure (mSBP) and blood pressure variability represented as standard deviation (sdSBP) using blood pressures from day 30 of the trial to the end of follow-up. We excluded blood pressures from the first 30 days to reduce confounding from the trial’s intervention. We fit a logistic regression model to ≥2 recurrent strokes from day 30 to the end of follow-up and, to accurately analyze the multiple failure-time data, we ordered the multiple failure events to the Prentice, Williams and Peterson extension of the Cox proportional-hazards model. Results: We included 2,882 patients, of which 223 had a recurrent stroke and 41/223 had ≥2 recurrent strokes for a total of 272 strokes. The mean (SD) number of blood pressure readings was 78.0 (37.4). The etiology of the 272 strokes was 161 (59.2%) lacunar, 22 (8.1%) intracranial atherosclerosis, 10 (3.7%) extracranial atherosclerosis, 24 (8.8%) cardioembolic, and 55 (20.2%) cryptogenic or other. In both unadjusted and adjusted logistic regression models and PWP Cox models, the top tertile of sdSBP was consistently predictive of multiple recurrent strokes, while mSBP was not (Tables 1/2). Conclusions: We found that in patients with an index lacunar stroke, higher SBP variability, but not mean SBP, was predictive of multiple recurrent strokes of varying mechanisms.

The effect of sickle cell anemia on the linear growth of Nigerian children

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ugo Nnenna Chikani ◽  
Adaobi Bisi-Onyemaechi ◽  
Ijeoma Ohuche ◽  
Justus Onu ◽  
Shalewa Ugege ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Linear Growth ◽  
Clinical Care ◽  
Growth Failure ◽  
Age At Diagnosis ◽  
Height Velocity ◽  
Prospective Longitudinal Study ◽  
High Prevalence ◽  
The Mean ◽  
Prospective Longitudinal

Abstract Objectives Despite the high prevalence of children with sickle cell anaemia (SCA) in West Africa, there is paucity of data on the height velocity and prevalence of growth failure in SCA patients. With advances in clinical care of SCA patients, could there be a spatial and secular trend in the growth pattern of these children? Hence, the compelling needs to embark on this study. The objectives of the study were to determine the prevalence of growth failure among patients with SCA and its correlation with age, gender and age at diagnosis. Methods A Prospective longitudinal study of a cohort of sickle cell anaemic paediatric patients from Pediatrics SCA Clinic, University of Nigeria Teaching Hospital, Ituku Ozalla. Patients were enrolled over a period of two years using a non-parametric convenient sampling method. Their heights were measured at baseline, three months, six months and at 12 months intervals and subsequently plotted on a standard WHO growth chart. The height velocities at different monthly intervals were calculated and compared with the WHO standard normal linear growth rates) for children (used as control) to identify those with GF. (i.e. <10th percentile). The main outcome measures were the mean height velocities at different months' intervals calculated and compared using the repeated measurement analysis of variance (ANOVA) and the Wilcoxon signed test. Results A cohort of 316 children aged 1–18 years with SCA was evaluated with a male preponderance of 161 (57.4%). The mean age and age at diagnosis were 11.04 ± 5.56 and 4.2 ± 1.7 years, respectively. The prevalence of growth failure and short stature was 84.7%. The burden of GF was highest among post-pubertal participants (94.1%). The most important predictor of growth velocity deficit was age (R2=0.045, standard β coefficient = −0.22, t=−03.51, p=0.001). Conclusions The study demonstrated high prevalence of growth failure in children and adolescents with SCA which intensified with advancement in age and older age at diagnosis.

scholarly journals Negative Air Pressure on Wet Cupping in Decreasing Blood Pressures in Hypertensive Patients

2018 ◽  
Vol 7 (2) ◽  
pp. 116
Author(s):  
Budi Darmawan ◽  
Diyah Fatmasari ◽  
Rr. Sri Endang Pujiast
Keyword(s):  
Blood Pressure ◽  
Repeated Measures ◽  
Community Health Centers ◽  
Intervention Group ◽  
Air Pressure ◽  
Control Group ◽  
P Value ◽  
Decrease Blood Pressure ◽  
Blood Pressures ◽  
The Mean

Background: Wet cupping, furthermore mentioned cupping, decreases blood pressures through the level of negative air pressures added by hydrostatics filtration pressure to reinforce the power of fluids filtration in capillaries. However, an appropriate negative air pressure to decrease blood pressure remains an uncertainty.Purpose: This study aimed to analyze negative air pressure differences on cupping in decreasing blood pressures in hypertensive patients.Methods: This is a quasi-experimental design conducted in three Community Health Centers in Langsa City, Aceh, Indonesia. The samples were 36 hypertensive males with age from 45 to 55, who were randomly stratified into two groups with cupping pressures 400 mbar (n=18) as the control group; and 540 mbar (n=18) as the intervention group. The cupping session was performed to each group on T1 (alkahil) point and in the middle line of both shoulders blade points. The systolic blood pressure (SBP) and diastolic blood pressures (DBP) were measured by validated automatic sphygmomanometer. The follow-up periods were one week and two weeks. The data were then analyzed by repeated measures ANOVA.Results: Cupping pressure of 400 mbar decreased the mean of SBP and DPB with a p-value of 0.450 and 0.026, respectively after two weeks of intervention. Meanwhile, cupping pressure of 540 mbar decreased the mean of SBP and DBP with a p-value of 0.006 and 0.057, respectively. Tests of within-subjects resulted in the p-value of 0.250 (SBP) and 0.176 (DBP) after two weeks of intervention. There were no significant differences in SBP and DBP between the intervention group and the control group.Conclusion: The cupping pressure between 400 mbar and 540 mbar could reduce blood pressure; however, the cupping pressure of 540 mbar yielded greater effect in decreasing blood pressure than the 400 mbar. Negative air vacuum pressure loads on cupping to decrease blood pressure should be considered between 400 to 540 mbar, and further studies are needed.

scholarly journals Evaluation of a random access analyser: BM/Hitachi 911

1995 ◽  
Vol 17 (6) ◽  
pp. 213-218
Author(s):  
Taweesook Kanluan ◽  
Surapon Tangvarasittichai ◽  
Orathai Tangvarasittichai
Keyword(s):  
Extreme Values ◽  
Random Access ◽  
Regression Analyses ◽  
The Mean ◽  
Carry Over

The performance of Boehringer Mannheim's BM/Hitachi 911 was evaluated for three months. The mean coeffcient of variation (CV) of the within-run and between-run imprecision of the 16 analytes were less than 1.16% (range 0.47-2.38%) and 1.35% (range 0.62-2.93,%), respectively. A linearity study for the various assays covered clinically important levels. No relevant drift was observed during an eight-hour assay nor was any sample-related carry-over detected. In all cases, the regression analyses (slopes) of the results obtainedfrom BM/Hitachi 911 and 717 were between the extreme values of 0.94 and 1.05. During the three months of operation, no major problem was encountered. The BM/Hitachi 911 was found to be easily operated, to require minimal attention and simple daily maintenance during operation.

scholarly journals Fibroblast Growth Factor 23 and Blood Pressure in Older Adults

Hypertension ◽  
2020 ◽  
Vol 76 (1) ◽  
pp. 236-243
Author(s):  
David A. Drew ◽  
Ronit Katz ◽  
Stephen Kritchevsky ◽  
Joachim H. Ix ◽  
Michael G. Shlipak ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Growth Factor ◽  
Fibroblast Growth Factor 23 ◽  
Fibroblast Growth ◽  
Antihypertensive Medications ◽  
Incident Hypertension ◽  
Blood Pressures ◽  
The Mean ◽  
Fgf 23

FGF-23 (fibroblast growth factor 23) regulates phosphorus and vitamin D. Elevated FGF-23 is associated with incident hypertension in young- and middle-aged adults, but there is limited data in older adults. Serum FGF-23 was measured using an intact ELISA assay in 2496 participants of the Healthy Aging and Body Composition Study. The association between FGF-23 and prevalent hypertension (self-reported and confirmed by use of antihypertensive medications) and number of antihypertensive medications was determined. The associations between FGF-23 and incident hypertension, and diastolic and systolic blood pressure trajectories were evaluated over 10 years. Models were adjusted for demographics, estimated glomerular filtration rate and albuminuria, cardiovascular disease risk factors, and measures of mineral metabolism. The mean (SD) age was 75 (3) years, with 51% women, and 40% black participants. The prevalence of hypertension at baseline was 75% and the mean systolic and diastolic blood pressures were 134 (21) mm Hg and 70 (12) mm Hg, respectively. The majority of participants without hypertension at baseline developed incident hypertension (576 of 1109 or 52%). In adjusted models, each 2-fold higher FGF-23 was associated with prevalent baseline hypertension (odds ratio=1.46 [1.24–1.73]) and greater number of blood pressure medications (IRR=1.14 [1.08–1.21]) but not with baseline diastolic or systolic blood pressure. In fully adjusted longitudinal analyses, a 2-fold higher FGF-23 was associated with incident hypertension (hazard ratio=1.18 [1.03–1.36]) and worsening systolic blood pressures (β=0.24 [0.08–0.40] mm Hg per year increase), but not with diastolic blood pressures (β=0.04 [−0.04 to 0.12] mm Hg per year increase). Higher FGF-23 concentrations are associated with prevalent and incident hypertension as well as rising systolic blood pressures in community-living older adults.

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