scholarly journals Accuracy of Inpatient Recall of Interaction With a Pharmacist: A Validation Study From 2 Acute Care Teaching Hospitals

2018 ◽  
Vol 6 (1) ◽  
pp. 62-67
Author(s):  
Vaninder K Sidhu ◽  
Lauren Bresee ◽  
Kyle Kemp ◽  
Sheri Koshman ◽  
Taciana Pereira ◽  
...  
Keyword(s):  
Acute Care ◽  
Care Setting ◽  
Teaching Hospitals ◽  
Survey Question ◽  
Predictive Values ◽  
Care Teaching ◽  
Current Survey ◽  
Sensitivity Specificity ◽  
Clinical Workload ◽  
Pharmacist Training

Background: Research has shown that inpatients may not accurately report interacting with a pharmacist. Objective: To determine accuracy of patients’ recollection of meeting with a pharmacist at 2 acute care teaching hospitals in Edmonton, Alberta, Canada. Methods: Retrospective review of 391 surveyed patients discharged from April 2013 to March 2014. Responses to meeting a pharmacist (yes/no) were compared with 2 reference standards: pharmacist documentation in patient charts and pharmacist clinical workload data. Sensitivity, specificity, positive predictive, and negative predictive values were calculated. Results: One hundred ninety-five (49.9%) respondents reported meeting with a pharmacist. Of these, 71 (36.4%) had corresponding pharmacist chart documentation. Of the 196 respondents who reported not speaking with a pharmacist, 73 (37.2%) had documentation present. Compared with patient charts, sensitivity and specificity were 49.3% and 49.8%, respectively. Positive and negative predictive values were 36.4% and 62.8%, respectively. Similar results were seen in comparison with the workload data. Conclusions: Patients often inaccurately reported meeting with a pharmacist in the acute care setting. The results are useful for pharmacist training, patient education, and for refinement of the current survey question.

Methicillin-Resistant Staphylococcus aureus in Tertiary Care Institutions of the Canadian Prairies 1990-1992

1994 ◽  
Vol 15 (10) ◽  
pp. 646-651 ◽  
Author(s):  
J. Embil ◽  
K. Ramotar ◽  
L. Romance ◽  
M. Alfa ◽  
J. Conly ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Acute Care ◽  
Gel Electrophoresis ◽  
Tertiary Care ◽  
Pulsed Field Gel Electrophoresis ◽  
Teaching Hospitals ◽  
Polymorphism Analysis ◽  
Canadian Prairies ◽  
Pulsed Field ◽  
Care Teaching

AbstractObjective:To review experience with methicillin-resistant Staphylococcus aureus (MRSA) in tertiary acute-care teaching hospitals on the Canadian prairies.Design:Retrospective review for a 36-month period, 1990 through 1992.Setting:Five tertiary acute-care teaching hospitals in three Canadian prairie provinces.Methods:MRSA isolates and susceptibility were identified through the clinical microbiology laboratory at each institution. For each patient, data collected included duration of institutional residence prior to isolation, patient ethnic background, age, sex, and antimicrobial susceptibility. Epidemiologic typing of strains used restriction fragment length polymorphism analysis by pulsed-field gel electrophoresis.Results:Two hundred fifty-nine MRSA isolates were identified in 135 patients during the 36 months, with substantial institutional variation in number of isolates. No consistent increase in yearly numbers of isolates was apparent. Patients usually had MRSA identified at admission (62%); only one of five centers had the majority of isolates acquired nosocomially. Patients with MRSA present at admission were more frequently of aboriginal (First Nations) ethnicity (62% compared with 14% of nosocomial; P<0.001). Pulsed-field gel electrophoresis of 167 isolates from 135 patients revealed 46 different strains with little interprovincial or inter-institutional identity of strains.Conclusions:MRSA isolated in patients in tertiary care institutions in these three Canadian provinces usually is acquired prior to admission. A disproportionate number of isolates are identified in aboriginal Canadians. Epidemiologic typing was consistent with a polyclonal origin of MRSA in this geographic area.

Inadequacy of Algorithmic Ventilator-Associated Pneumonia Diagnosis in Acute Care Surgery

2018 ◽  
Vol 84 (2) ◽  
pp. 300-304 ◽  
Author(s):  
Jacob A. Quick ◽  
Matthew D. Breite ◽  
Stephen L. Barnes
Keyword(s):  
Acute Care ◽  
Clinical Laboratory ◽  
Surgical Patients ◽  
Acute Care Surgery ◽  
Ventilator Associated Pneumonia ◽  
Predictive Values ◽  
Institutional Review ◽  
Care Surgery ◽  
Sensitivity Specificity ◽  
Diagnosis Criteria

Clinical utility of algorithms to diagnose ventilator-associated pneumonia (VAP) in surgical patients has not been established. We aimed to test the diagnostic accuracy of two established methods to reliably diagnose VAP in acutely ill and injured surgical patients. After institutional review board approval, we prospectively collected data on 508 mechanically ventilated acute care surgery patients. Microbiologic samples were taken daily from all patients. Demographics, clinical, laboratory, and radiographic data were collected. The Johanson Criteria (JC) and Clinical Pulmonary Infection Score (CPIS) were calculated and analyzed. Sensitivity, specificity, and positive predictive values (PPV) and negative predictive value (NPV) were calculated in comparison to positive respiratory cultures. Of the 508 patients, 312 (61.4%) were acutely injured; emergent general surgery was performed in 141 (27.8%) patients, and 54 (10.6%) underwent elective operation. Positive respiratory cultures were identified in 198 (39%) of the 508 patients. JC diagnosed VAP in 291 (57.3%) patients (sensitivity 82.8%, specificity 59%, PPV 56.4%, NPV 84.3%, accuracy 68.3%). The CPIS resulted in 189 (37.2%) VAP diagnoses (sensitivity 61.1%, specificity 78.1%, PPV 64%, NPV 75.9%, and accuracy 71.5%). To address the inaccuracy of the algorithms, concordance testing was performed on the data to evaluate correlation between the algorithmic VAP diagnosis criteria and respiratory culture data. Nonconcordance with culture data diagnosis was identified with both JC (rho 0.41) and CPIS (rho 0.41). Sensitivity, specificity, PPV and NPV, and accuracy of both established clinical formulas was unacceptably low in acute care surgery patients.

Downstream Impact of Urine Cultures Ordered without Indication at Two Acute Care Teaching Hospitals

2013 ◽  
Vol 34 (10) ◽  
pp. 1113-1114 ◽  
Author(s):  
Jerome A. Leis ◽  
Wayne L. Gold ◽  
Nick Daneman ◽  
Kaveh Shojania ◽  
Allison McGeer
Keyword(s):  
Acute Care ◽  
Antimicrobial Therapy ◽  
Asymptomatic Bacteriuria ◽  
Mount Sinai Hospital ◽  
Teaching Hospitals ◽  
Clinical Indication ◽  
Resistant Bacteria ◽  
Care Teaching ◽  
Clinical Indications ◽  
Study Team

Antimicrobial therapy for asymptomatic bacteriuria (ASB) is recommended for pregnant patients and those undergoing genitourinary procedures. In other populations, treatment has not been demonstrated to confer benefit and is associated with adverse drug reactions, selection for infection with increasingly drug-resistant bacteria, and Clostridium difficile infection. We undertook a prospective audit of urine culture ordering practices among medical and surgical inpatients at 2 acute care teaching hospitals to identify the proportion of urine cultures ordered without clinical indication that lead to antimicrobial therapy for ASB.During August and September 2012, consecutive urine cultures from nonpregnant ward patients were identified within 24 hours of culture ordering. Each patient was interviewed by the study team to determine the presence of urinary tract infection (UTI) using standard surveillance criteria. Non-catheterized patients met clinical indications for UTI if they had fever (temperature >38°C) without another explanation or at least 1 urinary symptom (dysuria, urgency, frequency, costovertebral angle tenderness, or suprapubic pain or tenderness). Catheterized patients met clinical indications for UTI if they had fever, suprapubic pain, or costovertebral angle tenderness. Other reasons for ordering cultures were documented on the basis of care provider interviews before culture results were known. Culture results and antimicrobial prescriptions were documented 72 hours later. The study was approved by the research ethics boards of Mount Sinai Hospital (472 beds) and University Health Network (408 beds; Toronto General Hospital site).

scholarly journals Performance of the tariff method and physicians in determining stroke as the cause of deaths using verbal autopsy in areas with a limited number of physicians: cases in Indonesia

2021 ◽  
Vol 12 (1) ◽  
pp. 39-46
Author(s):  
Endang Indriasih ◽  
Meiwita Budiharsana
Keyword(s):  
Positive Predictive Value ◽  
Cause Of Death ◽  
Verbal Autopsy ◽  
Predictive Value ◽  
Large Scale ◽  
Signs And Symptoms ◽  
Teaching Hospitals ◽  
Predictive Values ◽  
Tariff Method ◽  
Sensitivity Specificity

Background: Physician-certified verbal autopsy (PCVA) is the primary method used to determine the cause of death in Indonesia, although it is very costly and problematic to use in areas where physicians are not widely available with most deaths occur at home. The Tariff method has been piloted to obtain an alternative approach that does not require a physician to determine the cause of death. This validation study presents how the Tariff captures the correctness and distinctiveness of stroke symptoms to the PCVA. Methods: Medical records of 298 adult deaths that occured in four teaching hospitals in the Jakarta from  January 1, 2015 to March 2017 were collected prospectively. Verbal Autopsy (VA) was applied using the 2014 WHO instrument diagnosed by a trained physician (PCVA) and by Tariff method. The validity of the VA was assessed by comparing the PCVA diagnoses with the Tariff diagnoses, referring to the best standard. Results. Sensitivity, specificity and positive predictive value (PPV) of VAs using physician’s diagnosis (PCVA) for stroke were 73.9%, 73.5% and 93.4% respectively. The corresponding sensitivity, specificity and positive predictive value (PPV) of VAs diagnosed by the Tariff method were 75%, 61% and 91%. The negative predictive values (NPV) of both techniques were low, 35.6% and 32.6% respectively. Conclusion: The performance of the Tariff method for stroke was almost similar with  PCVA, and with a narrower variation, or more consistent than PCVA. Therefore, the Tariff method is a potential alternative to be used on a large scale, because the difficult geographical conditions where physician are not widely available for causes of deaths with distinct signs and symptoms. Keywords: verbal autopsy, sensitivity, specificity, determining cause of death, physician, tariff method   Abstrak Latar Belakang: Autopsi verbal yang disertifikasi oleh dokter (PCVA) merupakan metode utama yang digunakan untuk memastikan penyebab kematian di Indonesia. Meskipun sangat mahal dan bermasalah untuk digunakan di daerah di mana dokter tidak banyak tersedia dan sebagian besar kematian terjadi di rumah. Metode Tarif telah diujicobakan untuk mendapatkan pendekatan alternatif yang tidak memerlukan dokter untuk menentukan penyebab kematian. Studi validasi ini menyajikan bagaimana Tarif menangkap kebenaran dan kekhasan gejala stroke dibandingkan dengan PCVA. Metode: Rekam medis dari 298 kematian orang dewasa yang terjadi di empat rumah sakit studi di wilayah Jakarta pada 1 Januari 2015 hingga Maret 2017 dikumpulkan secara prospektif. Autopsi verbal (AV) dilakukan dengan menggunakan instrumen WHO 2014 yang didiagnosis oleh dokter terlatih (PCVA) dan metode Tarif. Validitas AV dinilai dengan membandingkan diagnosis PCVA dengan diagnosis metode Tarif, mengacu pada baku mutu. Hasil. Sensitivitas, spesifisitas dan nilai prediksi positif (PPV) dari AV dengan diagnosis dokter (PCVA) untuk stroke adalah 73,9%, 73,5% dan 93,4%. Sensitivitas, spesifisitas, dan nilai prediksi positif (PPV) yang sesuai dari AV yang didiagnosis dengan metode Tariff adalah 75%, 61% dan 91%. Nilai prediksi negatif (NPV) dari kedua teknik itu rendah, masing-masing 35,6% dan 32,6%. Kesimpulan: Untuk stroke, kinerja metode Tarif hampir sama dengan PCVA, dan dengan variasi yang lebih sempit, atau lebih konsisten dibandingkan PCVA. Oleh karena itu, untuk penyebab kematian dengan tanda dan gejala yang berbeda, metode Tarif merupakan alternatif potensial untuk digunakan dalam skala besar, di Indonesia dimana banyak wilayah dengan geografis sulit dan dokter tidak selalu tersedia. Kata kunci: autopsi verbal, sensitifitas, spesifisitas, penentuan penyebab kematian, dokter, metode tariff  

Discriminating Malignancy in Thyroid Nodules: The Nomogram Versus the Kwak and ACR TI-RADS

2020 ◽  
Vol 163 (6) ◽  
pp. 1156-1165
Author(s):  
Juan Xiao ◽  
Qiang Xiao ◽  
Wei Cong ◽  
Ting Li ◽  
Shouluan Ding ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Diagnostic Study ◽  
Diagnostic Efficiency ◽  
Training Set ◽  
Multivariable Logistic Regression Model ◽  
Predictive Values ◽  
Validation Set ◽  
Sensitivity Specificity

Objective To develop an easy-to-use nomogram for discrimination of malignant thyroid nodules and to compare diagnostic efficiency with the Kwak and American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS). Study Design Retrospective diagnostic study. Setting The Second Hospital of Shandong University. Subjects and Methods From March 2017 to April 2019, 792 patients with 1940 thyroid nodules were included into the training set; from May 2019 to December 2019, 174 patients with 389 nodules were included into the validation set. Multivariable logistic regression model was used to develop a nomogram for discriminating malignant nodules. To compare the diagnostic performance of the nomogram with the Kwak and ACR TI-RADS, the area under the receiver operating characteristic curve, sensitivity, specificity, and positive and negative predictive values were calculated. Results The nomogram consisted of 7 factors: composition, orientation, echogenicity, border, margin, extrathyroidal extension, and calcification. In the training set, for all nodules, the area under the curve (AUC) for the nomogram was 0.844, which was higher than the Kwak TI-RADS (0.826, P = .008) and the ACR TI-RADS (0.810, P < .001). For the 822 nodules >1 cm, the AUC of the nomogram was 0.891, which was higher than the Kwak TI-RADS (0.852, P < .001) and the ACR TI-RADS (0.853, P < .001). In the validation set, the AUC of the nomogram was also higher than the Kwak and ACR TI-RADS ( P < .05), each in the whole series and separately for nodules >1 or ≤1 cm. Conclusions When compared with the Kwak and ACR TI-RADS, the nomogram had a better performance in discriminating malignant thyroid nodules.

scholarly journals The Impact of Narrow-band Imaging on the Pre- and Intra- operative Assessments of Neoplastic and Preneoplastic Laryngeal Lesions. A Systematic Review

2020 ◽  
Author(s):  
Carmelo Saraniti ◽  
Enzo Chianetta ◽  
Giuseppe Greco ◽  
Norhafiza Mat Lazim ◽  
Barbara Verro
Keyword(s):  
White Light ◽  
Diagnostic Tool ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Resection Margins ◽  
Predictive Values ◽  
White Light Endoscopy ◽  
Laryngeal Lesions ◽  
Sensitivity Specificity ◽  
The Impact

Introduction Narrow-band imaging is an endoscopic diagnostic tool that, focusing on superficial vascular changes, is useful to detect suspicious laryngeal lesions, enabling their complete excision with safe and tailored resection margins. Objectives To analyze the applications and benefits of narrow-band imaging in detecting premalignant and malignant laryngeal lesions through a comparison with white-light endoscopy. Data Synthesis A literature search was performed in the PubMed, Scopus and Web of Science databases using strict keywords. Then, two authors independently analyzed the articles, read the titles and abstracts, and read completely only the relevant studies according to certain eligibility criteria. In total, 14 articles have been included in the present review; the sensitivity, specificity, positive and negative predictive values, and accuracy of pre- and/or intraoperative narrow-band imaging were analyzed. The analysis showed that narrow-band imaging is better than white-light endoscopy in terms of sensitivity, specificity, positive and negative predictive values, and accuracy regarding the ability to identify cancer and/or precancerous laryngeal lesions. Moreover, the intraoperative performance of narrow-band imaging resulted more effective than the in-office performance. Conclusion Narrow-band imaging is an effective diagnostic tool to detect premalignant and malignant laryngeal lesions and to define proper resection margins. Moreover, narrow-band imaging is useful in cases of leukoplakia that may cover a possible malignant lesion and that cannot be easily assessed with white-light endoscopy. Finally, a shared, simple and practical classification of laryngeal lesions, such as that of the European Laryngological Society, is required to identify a shared lesion management strategy. Key Points

scholarly journals Predicting youth diabetes risk using NHANES data and machine learning

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nita Vangeepuram ◽  
Bian Liu ◽  
Po-hsiang Chiu ◽  
Linhua Wang ◽  
Gaurav Pandey
Keyword(s):  
Machine Learning ◽  
Large Scale ◽  
Clinical Guideline ◽  
Diabetes Risk ◽  
Screening Tools ◽  
Clinical Screening ◽  
Predictive Values ◽  
Screening Guideline ◽  
Demographic Subgroups ◽  
Sensitivity Specificity

AbstractPrediabetes and diabetes mellitus (preDM/DM) have become alarmingly prevalent among youth in recent years. However, simple questionnaire-based screening tools to reliably assess diabetes risk are only available for adults, not youth. As a first step in developing such a tool, we used a large-scale dataset from the National Health and Nutritional Examination Survey (NHANES) to examine the performance of a published pediatric clinical screening guideline in identifying youth with preDM/DM based on American Diabetes Association diagnostic biomarkers. We assessed the agreement between the clinical guideline and biomarker criteria using established evaluation measures (sensitivity, specificity, positive/negative predictive value, F-measure for the positive/negative preDM/DM classes, and Kappa). We also compared the performance of the guideline to those of machine learning (ML) based preDM/DM classifiers derived from the NHANES dataset. Approximately 29% of the 2858 youth in our study population had preDM/DM based on biomarker criteria. The clinical guideline had a sensitivity of 43.1% and specificity of 67.6%, positive/negative predictive values of 35.2%/74.5%, positive/negative F-measures of 38.8%/70.9%, and Kappa of 0.1 (95%CI: 0.06–0.14). The performance of the guideline varied across demographic subgroups. Some ML-based classifiers performed comparably to or better than the screening guideline, especially in identifying preDM/DM youth (p = 5.23 × 10−5).We demonstrated that a recommended pediatric clinical screening guideline did not perform well in identifying preDM/DM status among youth. Additional work is needed to develop a simple yet accurate screener for youth diabetes risk, potentially by using advanced ML methods and a wider range of clinical and behavioral health data.

scholarly journals COVID-19 Seroprevalence among Healthcare Workers of a Large COVID-19 Hospital in Rome Reveals Strengths and Limits of Two Different Serological Tests

2021 ◽  
Vol 18 (5) ◽  
pp. 2650
Author(s):  
Giuseppe Vetrugno ◽  
Daniele Ignazio La Milia ◽  
Floriana D’Ambrosio ◽  
Marcello Di Pumpo ◽  
Roberta Pastorino ◽  
...  
Keyword(s):  
Blood Test ◽  
Healthcare Workers ◽  
Point Of Care ◽  
Venous Blood ◽  
Administrative Staff ◽  
Serological Tests ◽  
Predictive Values ◽  
Work From Home ◽  
Significant Difference ◽  
Sensitivity Specificity

Healthcare workers are at the forefront against COVID-19, worldwide. Since Fondazione Policlinico Universitario A. Gemelli (FPG) IRCCS was enlisted as a COVID-19 hospital, the healthcare workers deployed to COVID-19 wards were separated from those with limited/no exposure, whereas the administrative staff were designated to work from home. Between 4 June and 3 July 2020, an investigation was conducted to evaluate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin (IgG) antibodies among the employees of the FPG using point-of-care (POC) and venous blood tests. Sensitivity, specificity, and predictive values were determined with reverse-transcription polymerase chain reaction on nasal/oropharyngeal swabs as the diagnostic gold standard. The participants enrolled amounted to 4777. Seroprevalence was 3.66% using the POC test and 1.19% using the venous blood test, with a significant difference (p < 0.05). The POC test sensitivity and specificity were, respectively, 63.64% (95% confidence interval (CI): 62.20% to 65.04%) and 96.64% (95% CI: 96.05% to 97.13%), while those of the venous blood test were, respectively, 78.79% (95% CI: 77.58% to 79.94%) and 99.36% (95% CI: 99.07% to 99.55%). Among the low-risk populations, the POC test’s predictive values were 58.33% (positive) and 98.23% (negative), whereas those of the venous blood test were 92.86% (positive) and 98.53% (negative). According to our study, these serological tests cannot be a valid alternative to diagnose COVID-19 infection in progress.

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