Abstract WP395: Classification of Periventricular White Matter Disease (WMD) in Clinical Radiology Reports vs. Direct Film Review in Ischemic Stroke Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jonathan Hancher ◽  
Jane Eilerman ◽  
Kathleen Alwell ◽  
Heidi Sucharew ◽  
Charles J Moomaw ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
Periventricular White Matter ◽  
Kappa Score ◽  
Radiology Reports ◽  
Clinical Radiology ◽  
Mri Scans

Background: Severe WMD is associated with post-stroke mortality, recurrent stroke risk, cognitive decline, and poor functional outcomes. We have previously reported that “severe” WMD grade is likely when the clinical radiology report includes the words “severe, extensive, advanced, or diffuse”. We examined whether terms consistent with the Fazekas WMD grading scale (none, mild, moderate, or severe) in clinical radiology reports can be used to categorize WMD severity in epidemiologic stroke studies, and sought to repeat our factor analysis with descriptive terms. Methods: Clinical reports from 688 ischemic stroke subjects with MRI or CT films from 2010 were reviewed by physician investigators, who recorded whether WMD was described and whether the Fazekas terms or similar descriptors (such as diffuse, patchy, extensive, etc.) were used. A stroke neurologist and a research assistant independently evaluated available neuroimaging studies and categorized WMD severity according to the Fazekas grades. WMD was preferentially graded on MRI scans; CT scans were assessed if MRIs were unavailable or not performed. Kappa statistic was used to compare the grade mentioned in the report with our direct review; factor analysis was applied to the descriptor terms and logistic regression performed to examine predictive value of descriptor terms with WMD grade from direct review. Results: Of the 688, 276 had WMD radiologist grades available, 222 had no grades and no descriptors, and 190 had no grades but had descriptors. For all films with grades available, the weighted kappa score was 0.30, indicating poor agreement between the radiologist’s WMD grade and the reviewer’s WMD grade. Examining only the 231 MRI studies with WMD grades did not improve the weighted kappa score (0.34). Factor analysis found clusters of descriptors that were significantly associated with WMD grades: “scattered, minimal, tiny, punctate, spotty” with mild (p=0.0001); “multiple, patchy, diffuse” with moderate (p=0.01); and “advanced, confluent, extensive” with severe (p = 0.002). Discussion: Fazekas terms in clinical radiology reports do not seem to be useful by themselves, but descriptors used in clinical radiology reports may be utilized to approximate PVWMD severity.

scholarly journals Guidelines, training and quality assurance: influence on general practitioner MRI referral quality

2019 ◽  
Vol 11 (3) ◽  
pp. 235 ◽  
Author(s):  
Stephen Kara ◽  
Alexandra Smart ◽  
Tara Officer ◽  
Chan Dassanayake ◽  
Phil Clark ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Assurance ◽  
Odds Ratio ◽  
Patient Management ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
Direct Access ◽  
High Tech ◽  
Rater Agreement ◽  
Mri Scans

ABSTRACT INTRODUCTIONMagnetic resonance imaging (MRI) is an accurate diagnostic test used mainly in secondary care. Uncertainty exists regarding the ability of general practitioners (GPs) to use direct access high-tech imaging pathways appropriately when managing musculoskeletal injury. AIMTo evaluate the use of primary care-centric guidelines, training and quality assurance on the appropriateness of GP MRI referrals for patients with selected musculoskeletal injuries. METHODSThis is an 18-month primary care retrospective study. GPs participated in clinical musculoskeletal training, enabling patient referral for MRI on four body sites. Two reviewers categorised referral appropriateness independently, and reviewer inter-rater agreement between categorisations was measured. MRI results and patient management pathways were described. Associations of scan status and patient management were examined using logistic regression. RESULTSIn total, 273 GPs from 72 practices attended training sessions to receive MRI referral accreditation. Of these, 150 (55%) GPs requested 550 MRI scans, with 527 (96%) eligible for analysis, resulting in 86% considered appropriate; 79% consistent with guidelines and 7% clinically useful but for conditions outside of guidelines. Inter-rater agreement was 75%. Cohen’s weighted kappa statistic was 0.38 (95% CI: 0.28–0.48). MRI referrals consistent with guidelines were more likely to show pathology requiring specialist intervention (reviewer 1: odds ratio=2.64, 95% CI 1.51–4.62; reviewer 2: odds ratio=4.44, 95% CI 2.47–7.99), compared to scan requests graded not consistent. DISCUSSIONStudy findings indicate GPs use decision support guidance well, and this has resulted in appropriate MRI referrals and higher specialist intervention rates for selected conditions.

scholarly journals Corrigendum to: Guidelines, training and quality assurance: influence on general practitioner MRI referral quality

2019 ◽  
Vol 11 (4) ◽  
pp. 387
Author(s):  
Stephen Kara ◽  
Alexandra Smart ◽  
Tara Officer ◽  
Chan Dassanayake ◽  
Phil Clark ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Assurance ◽  
Odds Ratio ◽  
Patient Management ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
Direct Access ◽  
High Tech ◽  
Rater Agreement ◽  
Mri Scans

ABSTRACT INTRODUCTIONMagnetic resonance imaging (MRI) is an accurate diagnostic test used mainly in secondary care. Uncertainty exists regarding the ability of general practitioners (GPs) to use direct access high-tech imaging pathways appropriately when managing musculoskeletal injury. AIMTo evaluate the use of primary care-centric guidelines, training and quality assurance on the appropriateness of GP MRI referrals for patients with selected musculoskeletal injuries. METHODSThis is an 18-month primary care retrospective study. GPs participated in clinical musculoskeletal training, enabling patient referral for MRI on four body sites. Two reviewers categorised referral appropriateness independently, and reviewer inter-rater agreement between categorisations was measured. MRI results and patient management pathways were described. Associations of scan status and patient management were examined using logistic regression. RESULTSIn total, 273 GPs from 72 practices attended training sessions to receive MRI referral accreditation. Of these, 150 (55%) GPs requested 550 MRI scans, with 527 (96%) eligible for analysis, resulting in 86% considered appropriate; 79% consistent with guidelines and 7% clinically useful but for conditions outside of guidelines. Inter-rater agreement was 75%. Cohen's weighted kappa statistic was 0.38 (95% CI: 0.28–0.48). MRI referrals consistent with guidelines were more likely to show pathology requiring specialist intervention (reviewer 1: odds ratio=2.64, 95% CI 1.51–4.62; reviewer 2: odds ratio=4.44, 95% CI 2.47–7.99), compared to scan requests graded not consistent. DISCUSSIONStudy findings indicate GPs use decision support guidance well, and this has resulted in appropriate MRI referrals and higher specialist intervention rates for selected conditions.

P2549The cardiovascular predictors of clinical outcomes in patients after ischemic stroke of undetermined etiology

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bielecka-Dabrowa ◽  
P Gasiorek ◽  
A Sakowicz ◽  
M Banach
Keyword(s):  
Ischemic Stroke ◽  
Independent Predictor ◽  
Reference Group ◽  
Peak Velocity ◽  
Recurrent Stroke ◽  
Mitral Annular Velocity ◽  
Kaplan Meier ◽  
Unfavourable Prognosis ◽  
Undetermined Etiology

Abstract Purpose The study aimed to identify echocardiographic, hemodynamic and biochemical predictors of unfavourable prognosis after ischemic strokes of undetermined etiology (ESUS) in patients (pts) at age <65. Methods Out of 520 ischemic stroke pts we selected 64 pts diagnosed with ESUS [mean age 54 (SD: 47–58) years, 42% males] and additional 36 without stroke but with similar risk profile, which were treated as a reference group [age 53 (SD: 47–58) years, 61% males]. All pts underwent echocardiography, non-invasive assessment of hemodynamic parameters using SphygmoCor tonometer (Atcor Med., Australia), HDL subfraction distribution using Lipoprint (Quantimetrix) as well as measurements of selected biomarkers. Follow-up was 12 months. Results At 12-month follow-up 9% of patients had died, and recurrent ischemic stroke also occurred in 9% of patients - only in the ESUS group (Figure). Patients who died had significantly lower levels of LDL and HDL cholesterol (included HDL-8 and -9 subfractions) and higher level of triglicerides (p=0.01, p=0.01, and p=0.02; respectively), lower level of adiponectin (p=0.01), lower value of mean early diastolic (E') mitral annular velocity (p=0.04) and lower diastolic blood pressure (p=0.04). The atrial fibrillation (AF) occurred in 10% of pts during the 12 months (log-rang, p=0.254) (Figure). The log-rank test showed that ESUS group had a significantly poorer outcome of AF in the first 2 months after hospitalization compared to reference group (11% vs 5%, p=0.041). Based on a Kaplan-Meier analysis, the outcome of re-hospitalizationin the 1st year was 28% (18/64) in the ESUS group and 17% (6/36); log-rank, p=0.058. In the multivariate analysis mean early diastolic (E') mitral annular velocity (odds ratio [OR] 0.75, 95% confidence interval [CI]: 0.6–0.94; p=0.01) was significantly associated with CV hospitalizations assessed at 12-month follow-up. The only independent predictor of AF occurrence in the 12-month follow-up was lower value of Tissue Doppler-derived right ventricular systolic excursion velocity S' (OR 0.65, 95% Cl 0.45–0.93; p=0.01). The only independent predictor of recurrent stroke was the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion as determined by pulsed wave Doppler (E/E') (OR 0.75, 95% CI: 0.6–0.94; p=0.01). E/E' ratio was also independently associated with composite endpoint consisting of death, hospitalization and recurrent stroke (OR 1.90, 95% CI 1.1–3.2, p=0.01). Kaplan-Meier Analysis - survival and AF Conclusions The indices of diastolic dysfunction are significantly associated with unfavourable prognosis after ESUS. There is a robust role for outpatient cardiac monitoring especially during first 2 months after ESUS to detect potential AF. Acknowledgement/Funding The study was financed by research grants no. 502-03/5-139-02/502-54-229-18 of the Medical University of Lodz

scholarly journals Smart Health System to Detect Dementia Disorders Using Virtual Reality

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 810
Author(s):  
Areej Y. Bayahya ◽  
Wadee Alhalabi ◽  
Sultan H. AlAmri
Keyword(s):  
Virtual Reality ◽  
Clinical Diagnosis ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
Health Technology ◽  
P Value ◽  
Functional Evaluation ◽  
Medical Specialties ◽  
Weighted Kappa Statistic ◽  
Smart Health

Smart health technology includes physical sensors, intelligent sensors, and output advice to help monitor patients’ health and adjust their behavior. Virtual reality (VR) plays an increasingly larger role to improve health outcomes, being used in a variety of medical specialties including robotic surgery, diagnosis of some difficult diseases, and virtual reality pain distraction for severe burn patients. Smart VR health technology acts as a decision support system in the diseases diagnostic test of patients as they perform real world tasks in virtual reality (e.g., navigation). In this study, a non-invasive, cognitive computerized test based on 3D virtual environments for detecting the main symptoms of dementia (memory loss, visuospatial defects, and spatial navigation) is proposed. In a recent study, the system was tested on 115 real patients of which thirty had a dementia, sixty-five were cognitively healthy, and twenty had a mild cognitive impairment (MCI). The performance of the VR system was compared with Mini-Cog test, where the latter is used to measure cognitive impaired patients in the traditional diagnosis system at the clinic. It was observed that visuospatial and memory recall scores in both clinical diagnosis and VR system of dementia patients were less than those of MCI patients, and the scores of MCI patients were less than those of the control group. Furthermore, there is a perfect agreement between the standard methods in functional evaluation and navigational ability in our system where P-value in weighted Kappa statistic= 100% and between Mini-Cog-clinical diagnosis vs. VR scores where P-value in weighted Kappa statistic= 93%.

scholarly journals Development of an Automatic Functional Movement Screening System with Inertial Measurement Unit Sensors

2020 ◽  
Vol 11 (1) ◽  
pp. 96
Author(s):  
Wen-Lan Wu ◽  
Meng-Hua Lee ◽  
Hsiu-Tao Hsu ◽  
Wen-Hsien Ho ◽  
Jing-Min Liang
Keyword(s):  
Feature Selection ◽  
Inertial Measurement Unit ◽  
Learning Algorithm ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
Classification Model ◽  
Measurement Unit ◽  
Functional Movement ◽  
Inertial Measurement ◽  
Movement Screening

Background: In this study, an automatic scoring system for the functional movement screen (FMS) was developed. Methods: Thirty healthy adults fitted with full-body inertial measurement unit sensors completed six FMS exercises. The system recorded kinematics data, and a professional athletic trainer graded each participant. To reduce the number of input variables for the predictive model, ordinal logistic regression was used for subset feature selection. The ensemble learning algorithm AdaBoost.M1 was used to construct classifiers. Accuracy and F score were used for classification model evaluation. The consistency between automatic and manual scoring was assessed using a weighted kappa statistic. Results: When all the features were used, the predict model presented moderate to high accuracy, with kappa values between fair to very good agreement. After feature selection, model accuracy decreased about 10%, with kappa values between poor to moderate agreement. Conclusions: The results indicate that higher prediction accuracy was achieved using the full feature set compared with using the reduced feature set.

Are the Naranjo Criteria Reliable and Valid for Determination of Adverse Drug Reactions in the Intensive Care Unit?

2005 ◽  
Vol 39 (11) ◽  
pp. 1823-1827 ◽  
Author(s):  
Sandra L Kane-Gill ◽  
Levent Kirisci ◽  
Dev S Pathak
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Drug Reactions ◽  
Reliability And Validity ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
Drug Reactions ◽  
Rater Reliability ◽  
Cronbach Alpha

BACKGROUND The Naranjo criteria are frequently used for determination of causality for suspected adverse drug reactions (ADRs); however, the psychometric properties have not been studied in the critically ill. OBJECTIVE To evaluate the reliability and validity of the Naranjo criteria for ADR determination in the intensive care unit (ICU). METHODS All patients admitted to a surgical ICU during a 3-month period were enrolled. Four raters independently reviewed 142 suspected ADRs using the Naranjo criteria (review 1). Raters evaluated the 142 suspected ADRs 3–4 weeks later, again using the Naranjo criteria (review 2). Inter-rater reliability was tested using the kappa statistic. The weighted kappa statistic was calculated between reviews 1 and 2 for the intra-rater reliability of each rater. Cronbach alpha was computed to assess the inter-item consistency correlation. The Naranjo criteria were compared with expert opinion for criterion validity for each rater and reported as a Spearman rank (rs) coefficient. RESULTS The kappa statistic ranged from 0.14 to 0.33, reflecting poor inter-rater agreement. The weighted kappa within raters was 0.5402–0.9371. The Cronbach alpha ranged from 0.443 to 0.660, which is considered moderate to good. The rs coefficient range was 0.385–0.545; all rs coefficients were statistically significant (p < 0.05). CONCLUSIONS Inter-rater reliability is marginal; however, within-rater evaluation appears to be consistent. The inter-item correlation is expected to be higher since all questions pertain to ADRs. Overall, the Naranjo criteria need modification for use in the ICU to improve reliability, validity, and clinical usefulness.

2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack

2017 ◽  
Vol 12 (3) ◽  
pp. 302-320 ◽  
Author(s):  
Yongjun Wang ◽  
Ming Liu ◽  
Chuanqiang Pu
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Evidence Based ◽  
Cerebrovascular Disorder ◽  
Level Of Evidence ◽  
Vascular Stenosis ◽  
Ischemic Attack

Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.

EXPRESS: Risk factors for delayed-onset dementia after stroke or transient ischemic attack - A 5-year longitudinal cohort study

2021 ◽  
pp. 174749302110265
Author(s):  
Moamina Ismail ◽  
Vincent CT Mok ◽  
Adrian Wong ◽  
Lisa Au ◽  
Brian Yiu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Early Onset Dementia ◽  
Delayed Onset ◽  
Lower Baseline ◽  
History Of ◽  
Ischemic Attack ◽  
Moca Score

Background Stroke not only substantially increases the risk of incident dementia early after stroke, the risk remains elevated years after. Aim We aimed to determine the risk factors of dementia onset more than 3-6 months after stroke or transient ischemic attack (TIA). Methods This is a single center prospective cohort study. We recruited consecutive subjects with stroke/TIA without early-onset dementia. We conducted an annual neuropsychological assessment for 5 years. We investigated the association between baseline demographic, clinical, genetic (APOEε4 allele), and radiological factors, as well as incident recurrent stroke, with delayed-onset dementia using Cox proportional hazards models. Results 1,007 patients were recruited, of which 88 with early-onset dementia and 162 who lost to follow-ups were excluded. 49 (6.5%) out of 757 patients have incident delayed-onset dementia. The presence of ≥ 3 lacunes, history of ischemic heart disease (IHD), history of ischemic stroke and a lower baseline Hong Kong version of the Montreal Cognitive Assessment (MoCA) score, were significantly associated with delayed-onset dementia. APOEε4 allele, medial temporal lobe atrophy, and recurrent stroke were not predictive. Conclusion The presence of ≥ 3 lacunes, history of IHD, history of ischemic stroke and a lower baseline MoCA score, are associated with delayed-onset dementia after stroke/TIA.

Analysis of Cerebral Vascular Lesion Pools in Ischemic Stroke Based on the Analysis and the Prognostic Assessment of Risk Factors in Patients with Primary and Recurrent Ischemic Stroke

2016 ◽  
pp. 65-68
Author(s):  
Oksana Mikitey
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Significant Risk ◽  
Vascular Lesion ◽  
Assessment Tools ◽  
Vascular Lesions ◽  
Global Risk ◽  
Risk Assessment Tools

Stroke is an important medical and social problem, and stroke risk assessment tools have difficulty on the interaction of risk factors and the effects of certain risk factors with analysis by age, gender, race, because this information fully available to global risk assessment tools. In addition, these tools tend to be focused and usually do not include the entire range of possible factors contributing. The aim of the study was to conduct a comparison of brain vascular lesions pool with ischemic stroke (II) based predictive analysis and assessment of the main risk factors in patients with primary and recurrent ischemic stroke. Prognostically significant risk factors for recurrent ischemic stroke is not effective antihypertensive therapy, multiple stenoses any one pool vascular brain, duration of hypertension (AH) over 5 years and regular smoking patients (p<0.001). In the initial localization in the second vertebrobasilar recurrent stroke was significantly (p<0.05) more developed in the same pool in women than in men; and the localization of the primary carotid AI in the pool, re-developed stroke often unreliable in the same pool in women than in men.

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