Abstract TMP49: Yield of Diagnostic Evaluation in Major Stroke Phenoytypes

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jennifer J Majersik ◽  
Ethem M Arsava ◽  
Robert D Brown ◽  
Raji Grewal ◽  
Christina Jern ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Management Strategies ◽  
Cost Effective ◽  
Considerable Proportion ◽  
Evidence Based ◽  
Large Artery ◽  
Stroke Etiology ◽  
Cardiac Evaluation ◽  
Major Stroke

Background: Considerable disagreement exists among experts regarding the appropriate extent of diagnostic testing after ischemic stroke (IS). Evidence-based data guiding stroke evaluation for individual patients according to the underlying phenotype are unknown. We sought to determine the yield of cardiac and arterial evaluations for identifying an alternative major stroke etiology in patients with a given phenotype in the NINDS Stroke Genetics Network (SiGN). Methods: SiGN is a consortium of IS studies at 22 US and European sites aiming to identify stroke susceptibility genes. Adjudicators certified in Causative Classification of Stroke (CCS) system determined major etiologic stroke phenotypes based on chart review. All diagnostic data entered into the CCS software were stored in a confidential database. We determined the probability of identifying an alternative major abnormality based on cardiac (history, EKG, echocardiography) and arterial [intracranial (IC), extracranial (EC)] evaluations in 3 stroke phenotypes: lacunar infarct (LI), large artery atherosclerosis (LAA), and cardiac embolism (CE). Proportions of alternative major etiologies were calculated in patients with complete evaluations in each phenotype. Results: The analyses included 15720 patients. Among these, 2299 had phenotypic subtype of LI (1660 with cardiac and 1691 with arterial evaluations); 4228 had CE (2451 with arterial evaluation); and 2613 had LAA (2047 with cardiac evaluation). Cardiac evaluation revealed a major cardiac source of embolism in 12.3% of patients with LI and 20.3% with LAA. Echocardiography demonstrated an additional major structural cardiac source not seen by history/examination/EKG in 1.9% and 1.6% in LI and LAA respectively. Arterial evaluation led to the identification of ≥50%ipsilateral stenosis in 13.5% (IC: 8.9%, EC: 5.8%) of patients with LI and 17% (IC: 8.1%, EC: 11.3%) of those with CE. In LI patients with complete cardiac and vascular evaluations, 24.1% had an alternative major stroke etiology. Conclusions: A considerable proportion of IS patients with LI, LAA, and CE harbor an alternative major etiology. In the future, these results can be used to generate evidence-based and cost-effective evaluation and management strategies.

An evaluation of a shoulder rehabilitation class in a UK hospital following evidence-based modifications

2021 ◽  
pp. 1-8
Author(s):  
Emily Kell ◽  
John A. Hammond ◽  
Sophie Andrews ◽  
Christina Germeni ◽  
Helen Hingston ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Shoulder Pain ◽  
Management Strategies ◽  
Cost Effective ◽  
Rehabilitation Programme ◽  
Patient Specific ◽  
Satisfaction Survey ◽  
Evidence Based ◽  
Patient Satisfaction Survey ◽  
Significant Difference

OBJECTIVES: Shoulder pain is a common musculoskeletal disorder, which carries a high cost to healthcare systems. Exercise is a common conservative management strategy for a range of shoulder conditions and can reduce shoulder pain and improve function. Exercise classes that integrate education and self-management strategies have been shown to be cost-effective, offer psycho-social benefits and promote self-efficacy. This study aimed to examine the effectiveness of an 8-week educational and exercise-based shoulder rehabilitation programme following the introduction of evidence-based modifications. METHODS: A retrospective evaluation of a shoulder rehabilitation programme at X Trust was conducted, comparing existing anonymised Shoulder Pain and Disability Index (SPADI) and Patient-Specific Functional Scale (PSFS) scores from two cohorts of class participants from 2017-18 and 2018-19 that were previously collected by the physiotherapy team. Data from the two cohorts were analysed separately, and in comparison, to assess class efficacy. Descriptive data were also analysed from a patient satisfaction survey from the 2018-19 cohort. RESULTS: A total of 47 patients completed the 8-week shoulder rehabilitation programme during the period of data collection (2018-2019). The 2018-19 cohort showed significant improvements in SPADI (p 0.001) and PSFS scores (p 0.001). No significant difference was found between the improvements seen in the 2017-18 cohort and the 2018-19 cohort. 96% of the 31 respondents who completed the patient satisfaction survey felt the class helped to achieve their goals. CONCLUSION: A group-based shoulder rehabilitation class, which included loaded exercises and patient education, led to improvements in pain, disability and function for patients with rotator cuff related shoulder pain (RCRSP) in this outpatient setting, but anticipated additional benefits based on evidence were not observed.

Abstract W P183: Testing the Utility of an Emergency Room-Based Stroke Evaluation Protocol

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Gyeong-Moon Kim ◽  
Johanna Helenius ◽  
E Murat Arsava ◽  
Hakan Ay
Keyword(s):  
Emergency Department ◽  
Clinical Evaluation ◽  
Diagnostic Testing ◽  
Cost Effective ◽  
Vascular Imaging ◽  
Cardiac Monitoring ◽  
Evaluation Protocol ◽  
Evaluation Strategies ◽  
Fundamental Goal ◽  
Major Stroke

Background and purpose: A fundamental goal in diagnostic stroke evaluation is to identify the underlying etiology. We sought to determine the yield of an emergency department-based diagnostic evaluation protocol for identifying the etiology of stroke. Methods: We determined etiologic stroke subtypes using the automated Causative Classification System (CCS, available at https://ccs.mgh.harvard.edu) in 2422 consecutive patients with ischemic stroke at admission and discharge. Admission assessment was based on information from clinical evaluation, ECG, brain imaging (CT or MRI), and vascular imaging (CTA/MRA). Discharge CCS was performed blinded to the admission CCS subtype using information from additional tests such as echocardiography, cardiac monitoring, and special blood and CSF tests. Results: Table 1 shows the distribution of CCS subtypes. Overall, admission and discharge CCS subtypes were different in 29% of the patients. The size of “undetermined” category decreased from 37% at admission to 12% at discharge. The shift from “undetermined” to a known etiology was primarily due to detection of cardiac sources with low or uncertain risk of stroke (94%). The yield of investigations performed after admission in identifying a major known subtype was only 4.1% (p=0.008). Conclusions: A careful clinical evaluation and first-line diagnostic testing including brain and vascular imaging in the emergency department identify > 90% of those with a major stroke etiology. The low yield of additional testing suggests a need for developing cost-effective evaluation strategies in suspected patients.

scholarly journals Comparison of conventional and modern methods in determining ischemic stroke etiology by general and stroke neurologists

2019 ◽  
Author(s):  
REFİK KUNT ◽  
MUSTAFA KÜRŞAD KUTLUK ◽  
BEDİLE İREM TİFTİKÇİOĞLU ◽  
NAZİRE EFSER YEŞİM AFŞAR FAK ◽  
ALİ KEMAL ERDEMOĞLU ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Evidence Based ◽  
Q Value ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Subtype Assignment ◽  
Stroke Etiology ◽  
Medical Centers ◽  
Modern Methods

Background/aim: To investigate the consistency between stroke and general neurologists in subtype assignment using Trial of ORG-10172 using Acute Stroke Treatment (TOAST) and Causative Classification of Stroke (CCS) systems. Materials and methods: Fifty consecutive, acute ischemic stroke patients admitted to Stroke Unit were recruited. Patients were classified two stroke and two general neurologists, each from different medical centers, according to TOAST followed by CCS. Each neurologist was assessed for consistency and compliance in pairs. Concordance among all four neurologists was investigated and evaluated using Kappa(ĸ)-value. Results: Kappa(ĸ)-value of diagnostic compliance between stroke neurologists was 0.61 (95%CI 0.45-0.77) for TOAST and 0.78 (95%CI 0.62-0.94) for CSS-5. Kappa(ĸ)-value was 0.64 (95%CI 0.48–0.80) for TOAST and 0.75 (95%CI 0.60–0.91) for CCS-5 for general neurologists. Compliance was moderate [ĸ:0.59 (95%CI 0.52–0.65)] in TOAST and was strong [ĸ:0.75 (95%CI 0.68–0.81)] in CCS-5 for all 4 neurologists. ‘Cardioembolism’(91.04%) has reached the highest compliance in both systems. The frequency of group with ‘undetermined etiologies’ was less in CCS (26%) compared to TOAST. Conclusions: The CCS system improved the compliance in both stroke and general neurologists compared with TOAST. These suggest that automatic, evidence-based, easily reproducible CCS system was superior to TOAST system. Keywords: TOAST, CCS, Ischemic stroke, Etiology

scholarly journals Safety and Efficacy of Tirofiban for Acute Ischemic Stroke Patients With Large Artery Atherosclerosis Stroke Etiology Undergoing Endovascular Therapy

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiaochuan Huo ◽  
Raynald ◽  
Anxin Wang ◽  
Dapeng Mo ◽  
Feng Gao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Large Artery ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Safety And Efficacy ◽  
Stroke Etiology ◽  
Significant Difference ◽  
Major Stroke

Objective: To investigate the safety and efficacy of tirofiban in acute ischemic stroke (AIS) patients with large artery atherosclerosis (LAA) stroke etiology receiving endovascular therapy (EVT).Methods: In this multi-center prospective study, patients who were considered to have an indication received a low dose intra-arterial bolus (0.25–1 mg) of tirofiban. The safety and efficacy outcomes at 90-day follow-ups included symptomatic intracranial hemorrhage (sICH), recanalization rate, functional outcome, and mortality.Results: Among the 649 AIS patients with LAA, those in the tirofiban group (n = 244) showed higher systolic blood pressure (BP) and NIHSS score on admission, puncture-to-recanalization time, lower frequency of intravenous thrombolysis and intra-arterial thrombolysis, higher frequency of antiplatelet, heparinization, mechanical stent retrieval, aspiration, balloon angioplasty, and more retrieval times compared with those in the non-tirofiban group (n = 405) (all P < 0.05). Tirofiban was found to be associated with superior clinical outcomes in anterior circulation stroke and major stroke patients [adjusted odds ratio (OR) = 2.163, 95% confidence interval (CI) = 1.130–4.140, P = 0.02 and adjusted OR = 2.361, 95% CI = 1.326–4.202, P = 0.004, respectively] and a lower risk of mortality at 90-day follow-ups (adjusted OR = 0.159, 95% CI = 0.042–0.599, P = 0.007 and adjusted OR = 0.252, 95% CI = 0.103–0.621, P = 0.003, respectively). There was no significant difference in sICH between the two groups.Conclusions: Tirofiban in AIS patients with LAA undergoing EVT is safe and may benefit the functional outcomes in anterior circulation and major stroke patients and showed a trend for reduced mortality.

scholarly journals Laboratory Workup of Lymphoma in Adults

2020 ◽  
Author(s):  
Steven H. Kroft ◽  
Cordelia E. Sever ◽  
Adam Bagg ◽  
Brooke Billman ◽  
Catherine Diefenbach ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Clinical Pathology ◽  
Cost Effective ◽  
Primary Diagnosis ◽  
Aggressive Lymphoma ◽  
Evidence Based ◽  
Assessment Development ◽  
Evaluation Approach ◽  
Cost Effective Approach ◽  
American Society

Context.— The diagnostic workup of lymphoma continues to evolve rapidly as experience and discovery led to the addition of new clinicopathologic entities and techniques to differentiate them. The optimal clinically effective, efficient, and cost-effective approach to diagnosis that is safe for patients can be elusive, in both community-based and academic practice. Studies suggest that there is variation in practice in both settings. Objective.— To develop an evidence-based guideline for the preanalytic phase of testing, focusing on specimen requirements for the diagnostic evaluation of lymphoma. Design.— The American Society for Clinical Pathology, the College of American Pathologists, and the American Society of Hematology convened a panel of experts in the laboratory workup of lymphoma to develop evidence-based recommendations. The panel conducted a systematic review of literature to address key questions. Using the Grading of Recommendations Assessment, Development, and Evaluation approach, recommendations were derived based on the available evidence, strength of that evidence, and key judgements as defined in the Grading of Recommendations Assessment, Development, and Evaluation Evidence to Decision framework. Results.— Thirteen guideline statements were established to optimize specimen selection, ancillary diagnostic testing, and appropriate follow-up for safe and accurate diagnosis of indolent and aggressive lymphoma. Conclusions.— Primary diagnosis and classification of lymphoma can be achieved with a variety of specimens. Application of the recommendations can guide decisions on specimen suitability, diagnostic capabilities, and correct use of ancillary testing. Disease prevalence in patient populations, availability of ancillary testing, and diagnostic goals should be incorporated into algorithms tailored to each practice environment.

Laboratory Workup of Lymphoma in Adults

2020 ◽  
Vol 155 (1) ◽  
pp. 12-37
Author(s):  
Steven H Kroft ◽  
Cordelia E Sever ◽  
Adam Bagg ◽  
Brooke Billman ◽  
Catherine Diefenbach ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Clinical Pathology ◽  
Cost Effective ◽  
Primary Diagnosis ◽  
Aggressive Lymphoma ◽  
Evidence Based ◽  
Assessment Development ◽  
Cost Effective Approach ◽  
American Society ◽  
Evidence Based Guideline

Abstract Objectives The diagnostic workup of lymphoma continues to evolve rapidly as experience and discovery lead to the addition of new clinicopathologic entities and techniques to differentiate them. The optimal clinically effective, efficient, and cost-effective approach to diagnosis that is safe for patients can be elusive, in both community-based and academic practice. Studies suggest that there is variation in practice in both settings. The aim of this review is to develop an evidence-based guideline for the preanalytic phase of testing, focusing on specimen requirements for the diagnostic evaluation of lymphoma. Methods The American Society for Clinical Pathology, the College of American Pathologists, and the American Society of Hematology convened a panel of experts in the laboratory workup of lymphoma to develop evidence-based recommendations. The panel conducted a systematic review of the literature to address key questions. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, recommendations were derived based on the available evidence, the strength of that evidence, and key judgments as defined in the GRADE Evidence to Decision framework. Results Thirteen guideline statements were established to optimize specimen selection, ancillary diagnostic testing, and appropriate follow-up for safe and accurate diagnosis of indolent and aggressive lymphoma. Conclusions Primary diagnosis and classification of lymphoma can be achieved with a variety of specimens. Application of the recommendations can guide decisions about specimen suitability, diagnostic capabilities, and correct utilization of ancillary testing. Disease prevalence in patient populations, availability of ancillary testing, and diagnostic goals should be incorporated into algorithms tailored to each practice environment.

scholarly journals Quantitative Ship Collision Frequency Estimation Models: A Review

2021 ◽  
Vol 9 (5) ◽  
pp. 533
Author(s):  
Mirko Čorić ◽  
Sadko Mandžuka ◽  
Anita Gudelj ◽  
Zvonimir Lušić
Keyword(s):  
Risk Assessment ◽  
Collision Frequency ◽  
Frequency Estimation ◽  
Cost Effective ◽  
Future Improvement ◽  
Ship Collision ◽  
Estimation Models

Ship collisions are one of the most common types of maritime accidents. Assessing the frequency and probability of ship collisions is of great importance as it provides a cost-effective and practical way to mitigate risk. In this paper, we present a review of quantitative ship collision frequency estimation models for waterway risk assessment, accompanied by a classification of the models and a description of their main modelling characteristics. Models addressing the macroscopic perspective in the estimation of ship collision frequency on waterways are reviewed in this paper with a total of 29 models. We extend the existing classification methodology and group the collected models accordingly. Special attention is given to the criteria used to detect potential ship collision candidates, as well as to causation probability and the correlation of models with real ship collision statistics. Limitations of the existing models and future improvement possibilities are discussed. The paper can be used as a guide to understanding current achievements in this field.

scholarly journals Semi-automated regional classification of the style of activity of slow rock-slope deformations using PS InSAR and SqueeSAR velocity data

Landslides ◽  
2021 ◽  
Author(s):  
Chiara Crippa ◽  
Elena Valbuzzi ◽  
Paolo Frattini ◽  
Giovanni B. Crosta ◽  
Margherita C. Spreafico ◽  
...  
Keyword(s):  
Rock Slope ◽  
Progressive Failure ◽  
Principal Component ◽  
Cost Effective ◽  
Displacement Rate ◽  
Machine Learning Classification ◽  
Management Perspective ◽  
Alpine Environments

AbstractLarge slow rock-slope deformations, including deep-seated gravitational slope deformations and large landslides, are widespread in alpine environments. They develop over thousands of years by progressive failure, resulting in slow movements that impact infrastructures and can eventually evolve into catastrophic rockslides. A robust characterization of their style of activity is thus required in a risk management perspective. We combine an original inventory of slow rock-slope deformations with different PS-InSAR and SqueeSAR datasets to develop a novel, semi-automated approach to characterize and classify 208 slow rock-slope deformations in Lombardia (Italian Central Alps) based on their displacement rate, kinematics, heterogeneity and morphometric expression. Through a peak analysis of displacement rate distributions, we characterize the segmentation of mapped landslides and highlight the occurrence of nested sectors with differential activity and displacement rates. Combining 2D decomposition of InSAR velocity vectors and machine learning classification, we develop an automatic approach to characterize the kinematics of each landslide. Then, we sequentially combine principal component and K-medoids cluster analyses to identify groups of slow rock-slope deformations with consistent styles of activity. Our methodology is readily applicable to different landslide datasets and provides an objective and cost-effective support to land planning and the prioritization of local-scale studies aimed at granting safety and infrastructure integrity.

Factor Structure of the Scales for Assessing Emotional Disturbance : 3 Rating Scale for Students Identified With Emotional Disturbance

2021 ◽  
pp. 019874292110123
Author(s):  
Matthew C. Lambert ◽  
Douglas Cullinan ◽  
Michael H. Epstein ◽  
Jodie Martin
Keyword(s):  
Internal Structure ◽  
Emotional Disturbance ◽  
Factor Structure ◽  
Rating Scale ◽  
Factor Model ◽  
Distinct Group ◽  
Considerable Proportion ◽  
Evidence Based ◽  
Validity Evidence ◽  
Common Variance

This study examined the internal structure of the Scales for Assessing Emotional Disturbance-3 Rating Scale (RS), a teacher-completed RS developed to measure emotional disturbance (ED). As defined in U.S. law and regulations, ED involves five characteristics or patterns of behavioral and emotional maladaptation. RS data obtained on a sample of students with ED were used to examine validity evidence based on the internal structure of the assessment. Of particular interest was the extent to which multivariate factors derived from the RS data conform to the five characteristics of ED stated in the definition. Results indicate that the RS data fit a 5-factor model reasonably well. A subsequent bifactor analysis identified a considerable proportion of common variance across factors, suggesting the presence of a strong general ED factor, two distinct group factors (Inability to Learn and Inappropriate Behavior), and three weak group factors. The findings provided evidence of the validity of the SAED-3 RS based on internal structure and pointed to support for use of the RS in contributing to the process of determining whether a student qualifies for the ED education disability. Implications for improved research on the nature of ED and how students with ED can be better served are discussed.

scholarly journals Direct diagnostic testing of SARS-CoV-2 without the need for prior RNA extraction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shan Wei ◽  
Esther Kohl ◽  
Alexandre Djandji ◽  
Stephanie Morgan ◽  
Susan Whittier ◽  
...  
Keyword(s):  
Limit Of Detection ◽  
Point Of Care ◽  
Diagnostic Testing ◽  
Rna Extraction ◽  
Cost Effective ◽  
Clinical Samples ◽  
Nasopharyngeal Swab ◽  
Percentage Agreement ◽  
Testing Method ◽  
Viral Transport

AbstractThe COVID-19 pandemic has resulted in an urgent need for a rapid, point of care diagnostic testing that could be rapidly scaled on a worldwide level. We developed and tested a highly sensitive and robust assay based on reverse transcription loop mediated isothermal amplification (RT-LAMP) that uses readily available reagents and a simple heat block using contrived spike-in and actual clinical samples. RT-LAMP testing on RNA-spiked samples showed a limit of detection (LoD) of 2.5 copies/μl of viral transport media. RT-LAMP testing directly on clinical nasopharyngeal swab samples in viral transport media had an 85% positive percentage agreement (PPA) (17/20), and 100% negative percentage agreement (NPV) and delivered results in 30 min. Our optimized RT-LAMP based testing method is a scalable system that is sufficiently sensitive and robust to test for SARS-CoV-2 directly on clinical nasopharyngeal swab samples in viral transport media in 30 min at the point of care without the need for specialized or proprietary equipment or reagents. This cost-effective and efficient one-step testing method can be readily available for COVID-19 testing world-wide, especially in resource poor settings.

Sign in / Sign up

Export Citation Format

Share Document