Choosing screening instrument and cut-point on screening instruments. A comparison of methods

2009 ◽  
Vol 37 (8) ◽  
pp. 872-880 ◽  
Author(s):  
Hans J. Søgaard
Keyword(s):  
Rating Scale ◽  
Common Mental Disorders ◽  
Phase 1 ◽  
Health Economy ◽  
Phase 2 ◽  
Screening Instruments ◽  
Two Phase ◽  
Cut Point ◽  
The People ◽  
One Year

Aims: This study analyzes decisive measures of efficiency of a test, receiver operating characteristic (ROC) analysis and QROC analysis combined with considerations about clinical, health-economic, and ethical aspects when choosing screening instruments. Methods: Analyses of Common Mental Disorders Screening Questionnaire (CMD-SQ) and its subscales SCL-SOM, Whiteley-7, SCL-ANX4, SCL-DEP6, SCL-8, plus combinations, for early detection of psychiatric disorders, are the subject for this analysis. In all, 46.4% of 2,414 new people with continuous sickness absence for more than eight weeks over one year in a well-defined Danish population of 120,000 inhabitants participated in the study. The study was performed as a two phase study. All 1,121 persons in Phase 1 filled in the CMD-SQ. In Phase 2, a random subsample of Phase 1 on 337, the people were further examined by a psychiatrist using SCAN as gold standard. The analyses were performed as weighted analyses on Phase 2. Results: From 17 analyses it was shown that the efficiency of a test, ROC analyses, and QROC analyses resulted in different optimal scales and cut-points. The random possibility of a positive test or negative test in the population is discussed for efficiency and ROC analyses. QROC analyses correct for this by the relative κ-values as decisive measures. However, QROC analyses may discard tests of value, all depending on the purpose of the test. Conclusions: In supplement to test statistics the capacity of services to follow up on screening, ethics, and health economy are issues that should be considered in deciding what rating scale and cut-point should be adopted.

Compensating for non-response in a study estimating the incidence of mental disorders in long-term sickness absence by a two-phased design

2010 ◽  
Vol 38 (6) ◽  
pp. 625-632 ◽  
Author(s):  
Hans Jørgen Søgaard ◽  
Per Bech
Keyword(s):  
Mental Disorders ◽  
Mental Disorder ◽  
Sickness Absence ◽  
Common Mental Disorders ◽  
Phase 1 ◽  
Somatoform Disorder ◽  
Two Phase ◽  
One Year ◽  
Phase Design

Aims: The study compensates for the non-response that was observed in a previous study that estimated the frequencies of mental disorders in long-term sickness absence (LSA) (more than eight weeks of continuous sickness absence). In this study, the frequency of any mental disorder was estimated at 48% by a two-phase design and weighted logistic regression. The total non-response rate was 53.6%. This motivated the present study to compensate for non-response by applying adjustment of the weights and by multiple imputation of missing data in the estimation of the frequencies of mental disorders. Methods: The study took place in a Danish population of 120,000 inhabitants. During one year, all 2,414 incident individuals on LSA were identified. By a two-phase design 1,121 individuals were screened in Phase 1. In Phase 2, which was a subsample of Phase 1, 337 individuals participated in a psychiatric diagnostic examination applying Present State Examination as gold standard. The weighted analyses were based on scores of the screening instrument SCL-8AD compiled of SCL-8, SCL-ANX4, and SCL-DEP6 from the Common Mental Disorders Screening Questionnaire. In the present study, the variables sex, age, municipality, and social transfer income variables were used for the adjustment of weights in weighted analyses and in the imputation models. Results: The frequencies were: any mental disorder 46%—49%, depression 31%—36%, anxiety 13%—15%, and somatoform disorder 8%—9%. Conclusions: Irrespective of whether compensation for non-response was applied, the frequencies of mental disorders were similar. The variables used for the compensation were of problematic value.

scholarly journals Undetected Common Mental Disorders in Long-Term Sickness Absence

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Hans Joergen Soegaard
Keyword(s):  
Mental Disorders ◽  
Sick Leave ◽  
Return To Work ◽  
Sickness Absence ◽  
Common Mental Disorders ◽  
Phase 1 ◽  
Somatoform Disorder ◽  
Phase 2 ◽  
Two Phase

Background. Undetected Common Mental Disorders (CMDs) amongst people on sick leave complicate rehabilitation and return to work because appropriate treatments are not initiated. Aims. The aim of this study is to estimate (1) the frequencies of CMD, (2) the predictors of undetected CMD, and (3) the rate of return to work among sick listed individuals without a psychiatric disorder, who are registered on long-term sickness absence (LSA). Methods. A total of 2,414 incident individuals on LSA with a response rate of 46.4%, were identified for a two-phase study. The subsample of this study involved individuals registered on LSA who were sick-listed without a psychiatric sick leave diagnosis. In this respect, Phase 1 included 831 individuals, who were screened for mental disorders. In Phase 2, following the screening of Phase 1, 227 individuals were thoroughly examined by a psychiatrist applying Present State Examination. The analyses of the study were carried out based on the 227 individuals from Phase 2 and, subsequently, weighted to be representative of the 831 individuals in Phase 1. Results. The frequencies of undetected mental disorders among all sick-listed individuals were for any psychiatric diagnosis 21%, depression 14%, anxiety 4%, and somatoform disorder 6%. Conclusions. Undetected CMD may delay the initiation of appropriate treatment and complicate the rehabilitation and return to work.

Endometrial Adenocarcinoma in SurePath™ Cervical Samples: Cytological Features Revisited

2016 ◽  
Vol 60 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Nalini Gupta ◽  
John Crossley ◽  
Nick Dudding ◽  
John H.F. Smith
Keyword(s):  
Phase 1 ◽  
Endometrial Adenocarcinoma ◽  
Nuclear Chromatin ◽  
Phase 2 ◽  
Cervical Lesions ◽  
Two Phase ◽  
Endometrial Cells ◽  
Phase Study ◽  
Cytological Features ◽  
Liquid Based Cytology

Objective: The cytomorphological criteria of malignant endometrial lesions in cervical samples are less well described than those of cervical lesions. We wished to investigate if there were features in SurePath™ liquid-based cytology samples that would facilitate more accurate differentiation between benign and malignant endometrial cells. Study Design: This was a two-phase study, with a review of all SurePath™ samples reported as endometrial adenocarcinoma (n = 42) evaluating 12 cytological features in the first phase. In phase 2 (test set), all initial cases plus an additional 83 cases were reviewed using these 12 cytological features to predict the outcome. Results: Out of 12 cytological features evaluated in phase 1 (training set), nuclear chromatin pattern, apoptotic bodies and tingible body macrophages were found to be the most significant features determining malignant histological outcome. These 12 cytological features were re-evaluated in phase 2 (n = 125). Of 125 cases, 54 had a benign and 71 had a malignant or premalignant histological outcome, with a positive predictive value of 56.8%. Conclusion: Granular nuclear chromatin, tingible body macrophages and apoptosis in the background are the most significant factors in determining whether endometrial cells present in cervical samples represent malignancy or are benign. Using these features, relatively accurate predictions of endometrial pathology can be made.

scholarly journals Developing a realist theory of psychosocial rehabilitation: the Clubhouse model

2021 ◽  
Author(s):  
Christina Mutschler ◽  
Jen Rouse ◽  
Kelly McShane ◽  
Criss Habal-Brosek
Keyword(s):  
Phase 1 ◽  
Psychosocial Rehabilitation ◽  
Theory Development ◽  
Realist Evaluation ◽  
Self Determination ◽  
Phase 2 ◽  
Two Phase ◽  
Realist Theory ◽  
Clubhouse Model ◽  
Two Phases

Background Psychosocial rehabilitation is a service that supports recovery from mental illness by providing opportunities for skill development, self-determination, and social interaction. One type of psychosocial rehabilitation is the Clubhouse model. The purpose of the current project was to create, test, and refine a realist theory of psychosocial rehabilitation at Progress Place, an accredited Clubhouse. Method Realist evaluation is a theory driven evaluation that uncovers contexts, mechanisms, and outcomes, in order to develop a theory as to how a program works. The current study involved two phases, encompassing four steps: Phase 1 included (1) initial theory development and (2) initial theory refinement; and Phase 2 included (3) theory testing and (4) refinement. Results The data from this two-phase approach identified three demi-regularities of recovery comprised of specific mechanisms and outcomes: the Restorative demi-regularity, the Reaffirming demi-regularity, and the Re-engaging demi-regularity. The theory derived from these demi-regularities suggests that there are various mechanisms that produce outcomes of recovery from the psychosocial rehabilitation perspective, and as such, it is necessary that programs promote a multifaceted, holistic perspective on recovery. Conclusions The realist evaluation identified that Progress Place promotes recovery for members. Additional research on the Clubhouse model should be conducted to further validate that the model initiates change and promotes recovery outcomes.

scholarly journals Whole system approaches to health in higher education

2019 ◽  
Vol 119 (4) ◽  
pp. 246-258
Author(s):  
Mark Dooris ◽  
Alan Farrier ◽  
Susan Powell ◽  
Maxine Holt
Keyword(s):  
Higher Education ◽  
Phase 1 ◽  
International Perspective ◽  
Phase 2 ◽  
Structured Interviews ◽  
Two Phase ◽  
Content Type ◽  
Key Issues ◽  
Strategic Influence ◽  
The Uk

Purpose The purpose of this paper is to report on an evaluation of the UK Healthy Universities Network (UKHUN), which explored engagement of network members; identified what members value about the network; examined facilitators and barriers to engagement; and informed the network’s future development. Design/methodology/approach The study was a two phase mixed-method study, with participants being staff from Higher Education institutions. Phase 1 involved a documentary review and an online 14-question survey (n=32). Phase 2 comprised follow-up semi-structured interviews and focus groups, conducted using Skype (n=11). These were audio recorded and transcripts were thematically analysed in a two-stage process. Findings A number of key themes emerged from the thematic analysis: value of network meetings and events; popularity of the network website; increased communication and collaboration; sense of leadership offered by the network; interest and inclusion of an international perspective; importance of institutional support. Research limitations/implications Only six universities who are involved in the network took part in Phase 2. Although a range of organisations were chosen purposively, it is possible that additional key issues at other universities were excluded. Originality/value The UKHUN is valued by its membership, particularly its biannual meetings, online presence, leadership, ethos and communication methods. Key barriers include the capacity of staff to attend meetings and contribute to the network, influenced by a lack of institutional commitment and prioritisation. Findings from the evaluation have informed a “refresh” of the network’s website and a revision of its membership structure, as well as guiding its positioning to achieve greater strategic influence.

A computationally fast approach to maximum‐likelihood deconvolution

Geophysics ◽  
1984 ◽  
Vol 49 (5) ◽  
pp. 550-565 ◽  
Author(s):  
Chong‐Yung Chi ◽  
Jerry M. Mendel ◽  
Dan Hampson
Keyword(s):  
Maximum Likelihood ◽  
Initial Conditions ◽  
Phase 1 ◽  
Real Data ◽  
Phase 2 ◽  
Statistical Parameters ◽  
Two Phase ◽  
Nonminimum Phase ◽  
Fast Approach ◽  
Fine Adjustment

In this paper we derive and implement a maximum‐likelihood deconvolution (MLD) algorithm, based on the same channel and statistical models used by Kormylo and Mendel (1983a), that leads to many fewer computations than their MLD algorithm. Both algorithms can simultaneously estimate a nonminimum phase wavelet and statistical parameters, detect locations of significant reflectors, and deconvolve the data. Our MLD algorithm is implemented by a two‐phase block component method (BCM). The phase‐1 block functions like a coarse adjustment of unknown quantities and provides a set of good initial conditions for the phase‐2 block, which functions like a fine adjustment of unknown quantities. We demonstrate good performance of our algorithm for both synthetic and real data.

Phase I/II study of MKC-1 and pemetrexed (PEM) as second-line therapy in patients (pts) with advanced non-small cell lung cancer (NSCLC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19005-e19005
Author(s):  
N. H. Hanna ◽  
D. Estes ◽  
J. Arnott ◽  
S. Marcotte ◽  
A. Hannah ◽  
...  
Keyword(s):  
Phase 1 ◽  
Combined Treatment ◽  
Single Agent ◽  
Second Line ◽  
Phase 2 ◽  
Second Line Therapy ◽  
Line Therapy ◽  
Best Response ◽  
Grade 3 ◽  
One Year

e19005 Background: MKC-1 is a novel oral cell cycle inhibitor with preclinical activity against NSCLC cell lines including multi-drug resistant lines, and single agent activity in NSCLC pts. Binding targets of MKC-1 include microtubules, members of the importin-β family and AKT-mTOR. This phase 1/2 study evaluated MKC-1 in combination with PEM as second-line therapy in pts with advanced NSCLC. Methods: Eligible pts had NSCLC previously treated with one regimen for metastatic disease or disease progression within one year following adjuvant and neoadjuvant therapy. Phase 1 dose escalation used 3+3 design. Phase 2 pts were treated with MKC-1 at 75 mg/m2 given p.o. BID for 14 days along with PEM at 500 mg/m2 given i.v. on day 1 of each 21 day cycle. Following 4 cycles of combined treatment, single agent MKC-1 was continued as maintenance therapy. An interim analysis after 17 pts in phase 2 would allow accrual to continue provided one response was confirmed. Results: 27 pts were enrolled (8 in phase 1 and 19 in phase 2). Median age/PS for phase 2 is 64/1 and 89% had adenocarcinoma. Total # of treatment cycles to date for phase 2 pts is 95, with a median of 4 cycles. Of the 19 phase 2 pts, 18 were evaluable for tumor response. The best response was confirmed PR, noted in 3 pts. 5 additional pts (4 confirmed) had minor responses (>10% but <30% shrinkage). One additional pt continues on study with stable disease for >18 months. In phase 2 (n=19), all grade toxicities were anorexia (59%), fatigue (63%), nausea (58%), and dyspnea (48%). Grade 3/4 toxicities included fatigue (26%); neutropenia (22%); dyspnea, anorexia, AST and ALT elevation (11% each); nausea and constipation (5% each). 7 pts had at least one dose reduction of both PEM and MKC-1 and 3 additional pts had only MKC-1 reduced. Median PFS was 86 days with two pts continuing on study (treated for 530+ days and 140+ days, respectively). Conclusions: The phase 2 dose of MKC-1 (75 mg/m2 BID) and PEM (500 mg/m2) has been defined. The combination is well tolerated with 17% of patients achieving a confirmed PR thus far. A decision to proceed with additional accrual in this single arm study versus initiating a randomized phase 2 study of this combination is pending. [Table: see text]

scholarly journals Early Diagnostic Marker Panel Determination for Microarray Based Clinical Studies

2005 ◽  
Vol 4 (1) ◽  
Author(s):  
Jochen Jaeger ◽  
Dieter Weichenhan ◽  
Boris Ivandic ◽  
Rainer Spang
Keyword(s):  
Phase 1 ◽  
Classification Model ◽  
Marker Genes ◽  
Phase 2 ◽  
Two Phase ◽  
Marker Panel ◽  
Performance Loss ◽  
Genome Wide ◽  
Number Of Patients ◽  
Cost Efficient

We present a novel, cost efficient two-phase design for predictive clinical gene expression studies: early marker panel determination (EMPD). In Phase-1, genome-wide microarrays are used only for a small number of individual patient samples. From this Phase-1 data a panel of marker genes is derived. In Phase-2, the expression values of these marker panel genes are measured for a large group of patients and a predictive classification model is learned from this data. Phase-2 does not require the use of expensive whole genome microarrays, thus making EMPD a cost efficient alternative for current trials. The expected performance loss of EMPD is compared to designs which use genome-wide microarrays for all patients. We also examine the trade-off between the number of patients included in Phase-1 and the number of marker genes required in Phase-2. By analysis of five published datasets we find that in Phase-1 already 16 patients per group are sufficient to determine a suitable marker panel of 10 genes, and that this early decision compromises the final performance only marginally.

scholarly journals Stem cell factor amplifies newborn and sickle erythropoiesis in liquid cultures

Blood ◽  
1993 ◽  
Vol 81 (10) ◽  
pp. 2591-2599 ◽  
Author(s):  
RS Weinberg ◽  
JC Thomson ◽  
R Lao ◽  
G Chen ◽  
BP Alter
Keyword(s):  
Stem Cell ◽  
Progenitor Cells ◽  
Stem Cell Factor ◽  
Mononuclear Cells ◽  
Phase 1 ◽  
Newborn Infants ◽  
Cell Number ◽  
Phase 2 ◽  
Two Phase ◽  
Erythroid Progenitor

A two-phase liquid-culture system was used to substantially amplify and differentiate erythroblasts, starting with mononuclear cells from the blood of normal adults, newborn infants, and patients with sickle cell anemia. After the first 7 days (phase 1), in medium plus fetal bovine serum (FBS) alone, or in combination with stem cell factor (SCF) or conditioned medium (CM), the cell number was unchanged, and the cells all looked like lymphocytes. These cells were then diluted into medium with erythropoietin (Ep) alone, with Ep and either SCF or CM, or in methylcellulose with the same factors (phase 2). After 14 days in liquid phase 2 with SCF and Ep, the cell numbers increased an average of 30-fold in the sickle, 24-fold in the newborn, and 4-fold in the normal adult cultures; almost all the cells were erythroblasts and erythrocytes. SCF in phase 1 increased the number of late progenitors (CFU-E) assayed in methylcellulose, with the largest number in sickle, followed by newborn cultures and then adult cultures. We conclude that erythroid progenitor cells survive for at least 7 days without Ep (but with FBS). Progenitor cells are amplified, particularly with SCF. Later in culture, SCF with Ep increases the final number of differentiated erythroid cells. Both the early and the late effects of SCF are most effective in sickle, followed by newborn cultures and then adult cultures.

scholarly journals Enhancing Label Representations with Relational Inductive Bias Constraint for Fine-Grained Entity Typing

2021 ◽  
Author(s):  
Jinqing Li ◽  
Xiaojun Chen ◽  
Dakui Wang ◽  
Yuwei Li
Keyword(s):  
State Of The Art ◽  
Phase 1 ◽  
Phase 2 ◽  
Two Phase ◽  
Inductive Bias ◽  
Fine Grained ◽  
Wide Range ◽  
Dynamic Experiments ◽  
Novel Method ◽  
Public Datasets

Fine-Grained Entity Typing (FGET) is a task that aims at classifying an entity mention into a wide range of entity label types. Recent researches improve the task performance by imposing the label-relational inductive bias based on the hierarchy of labels or label co-occurrence graph. However, they usually overlook explicit interactions between instances and labels which may limit the capability of label representations. Therefore, we propose a novel method based on a two-phase graph network for the FGET task to enhance the label representations, via imposing the relational inductive biases of instance-to-label and label-to-label. In the phase 1, instance features will be introduced into label representations to make the label representations more representative. In the phase 2, interactions of labels will capture dependency relationships among them thus make label representations more smooth. During prediction, we introduce a pseudo-label generator for the construction of the two-phase graph. The input instances differ from batch to batch so that the label representations are dynamic. Experiments on three public datasets verify the effectiveness and stability of our proposed method and achieve state-of-the-art results on their testing sets.

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