scholarly journals Development and validation of the Sorting non-trauMatIc adoLescent knEe pain (SMILE) tool – a development and initial validation study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Clara Guldhammer ◽  
Sinead Holden ◽  
Marina Elmelund Sørensen ◽  
Jens Lykkegaard Olesen ◽  
Martin Bach Jensen ◽  
...  
Keyword(s):  
Knee Pain ◽  
Gold Standard ◽  
Sports Medicine ◽  
Kappa Statistic ◽  
Medical Doctors ◽  
Clinical Tests ◽  
Support Tool ◽  
Expert Clinician ◽  
Diagnostic Flowchart ◽  
Development And Validation

Abstract Background Despite the commonality of adolescent knee pain, there are no tools to support medical doctors to correctly diagnose knee pain. This study aimed to develop and evaluate a support tool for diagnosing the most common types of non-traumatic adolescent knee pain. Method A systematic search on Medline identified the literature on clinical tests and diagnoses of adolescent knee pain. The search was supplemented by textbooks and transformed into a diagnostic flowchart based on onset, symptoms, and pain localisation. This tool was revised based on feedback from general practitioners and experts in sports medicine. The tool was evaluated on two separate days with blinded assessors. Overall, 27 participants (aged 10–17 years) with non-traumatic knee pain were included. All participants were diagnosed by medical doctors or medical students, without and with the use of the tool. Diagnoses were compared to a gold standard (expert clinician). An interview to inform optimisations of the tool was performed with the assessors. Percentage agreement with the gold standard, and Kappa statistic for interrater reliability were calculated. Results The final tool improved diagnostic agreement with the gold standard from 22.7% (95% CI 10.3–35.1) to 77.3% (95% CI 64.9–89.7). Inter-rater reliability increased from poor agreement k = − 0.04 (95% CI, − 0.12-0.04) to moderate agreement k = 0.56 (95% CI, 0.40–0.72). Conclusion This simple diagnostic tool is quick to use and may assist doctors in diagnosing non-traumatic knee pain in adolescents.

scholarly journals Development and validation of the Sorting non-trauMatIc adoLescent knEe pain (SMILE) tool – a development and initial validation study

2020 ◽  
Author(s):  
Clara Guldhammer ◽  
Sinead Holden ◽  
Marina Elmelund Sørensen ◽  
Jens Lykkegaard Olesen ◽  
Martin Bach Jensen ◽  
...  
Keyword(s):  
Knee Pain ◽  
Gold Standard ◽  
Sports Medicine ◽  
Kappa Statistic ◽  
Medical Doctors ◽  
Clinical Tests ◽  
Support Tool ◽  
Expert Clinician ◽  
Diagnostic Flowchart ◽  
Development And Validation

Abstract Background: Despite the commonality of adolescent knee pain, there are no tools to support medical doctors to correctly diagnose knee pain. This study aimed to develop and evaluate a support tool for diagnosing the most common types of non-traumatic adolescent knee pain.Method: A systematic search on Medline identified the literature on clinical tests and diagnoses of adolescent knee pain. The search was supplemented by textbooks and transformed into a diagnostic flowchart based on onset, symptoms, and pain localisation. This tool was revised based on feedback from general practitioners and experts in sports medicine. The tool was evaluated on two separate days with blinded assessors. Overall, 27 participants (aged 10-17 years) with non-traumatic knee pain were included. All participants were diagnosed by medical doctors or medical students, without and with the use of the tool. Diagnoses were compared to a gold standard (expert clinician). An interview to inform optimisations of the tool was performed with the assessors. Percentage agreement with the gold standard, and Kappa statistic for interrater reliability were calculated.Results: The final tool improved diagnostic agreement with the gold standard from 22.7% (95% CI 10.3-35.1) to 77.3% (95% CI 64.9-89.7). Inter-rater reliability increased from poor agreement k=-0.04 (95% CI, -0.12-0.04) to moderate agreement k=0.56 (95% CI, 0.40-0.72).Conclusion: This simple diagnostic tool is quick to use and may assist doctors in diagnosing non-traumatic knee pain in adolescents.

scholarly journals Development and Validation of the Sorting Non-trauMatIc adoLescent knEe Pain (SMILE) Tool – a Development and Validation Study

2020 ◽  
Author(s):  
Clara Guldhammer ◽  
Sinead Holden ◽  
Marina Elmelund Sørensen ◽  
Jens Lykkegaard Olesen ◽  
Martin Bach Jensen ◽  
...  
Keyword(s):  
Knee Pain ◽  
Validation Study ◽  
Sports Medicine ◽  
Kappa Statistic ◽  
Medical Doctors ◽  
Support Tool ◽  
Golden Standard ◽  
Expert Clinician ◽  
Diagnostic Flowchart ◽  
Development And Validation

Abstract Background: Despite the commonality of adolescent knee pain, there are no tools to support medical doctors to correctly diagnose knee pain. Aim: This study aimed to develop and evaluate a support tool for diagnosing the most common types of non-traumatic adolescent knee pain.Design and setting: Development and validation study in participants recruited from the general community. Method: A systematic search on Medline identified the literature on clinical tests and diagnoses of adolescent knee pain. The search was supplemented by textbooks and transformed into a diagnostic flowchart based on onset, symptoms, and pain localisation. This tool was revised based on feedback from general practitioners and experts in sports medicine. The tool was evaluated on two separate days with blinded assessors. Overall, 27 participants (aged 10-17 years) with non-traumatic knee pain were included. All participants were diagnosed by medical doctors or medical students, without and with the use of the tool. Diagnoses were compared to a golden standard (expert clinician). An interview to inform optimisations of the tool was performed with the assessors. Percentage agreement with the golden standard, and Kappa statistic for interrater reliability were calculated.Results: The final tool improved diagnostic agreement with the golden standard from 22.7% (95% CI 10.3-35.1) to 77.3% (95% CI 64.9-89.7). Inter-rater reliability increased from poor agreement k=-0.04 (95% CI, -0.12-0.04) moderate agreement k=0.56 (95% CI, 0.40-0.72).Conclusion: This simple diagnostic tool is quick to use and may assist doctors in diagnosing non-traumatic knee pain in adolescents.Trial registration: Not applicable.

scholarly journals Using Telemedicine to Pre-Screen Sports Medicine Patients in the Ambulatory Setting Reduces Wait Times and Maximizes Provider-Patient Interaction

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0041
Author(s):  
Alfred Atanda ◽  
Kathryn Leyden ◽  
Medical Student
Keyword(s):  
Patient Satisfaction ◽  
Knee Pain ◽  
Sports Medicine ◽  
Clinic Visit ◽  
Background Information ◽  
Full Time ◽  
Visit Time ◽  
Medicine Clinic ◽  
Exam Room ◽  
Room Time

Objectives: Gathering of background information during a clinic visit can be time-consuming. Some medical specialties have workflows that pre-screen patients ahead of time to minimize delays. Having background information ahead of time may decrease delays and ensure that the visit is focused on physical examination, diagnosis, and treatment. We have used telemedicine to treat established patients to reduce cost and resource utilization, while maintaining high levels of patient satisfaction. It is conceivable that telemedicine could also be used to pre-screen new patients prior to their in-person clinic visit. The goal of the current study was to evaluate whether utilizing telemedicine to pre-screen new patients to our sports medicine clinic would reduce time in the exam room waiting and being seen, and overall clinic times. Methods: From June 2018 through August 2018, we utilized videoconferencing telemedicine to pre-screen all new patients to a pediatric sports medicine clinic with a chief diagnosis of knee pain. Visits were performed by full-time telemedicine pediatricians who were provided appropriate training and an intake form describing which questions should be asked. All visits utilized the American Well software platform (Boston, USA) and were performed on the patient’s personal device. During the subsequent in-person visit, the overall timing of the visit was recorded including: time checked in, time waiting in waiting room, time waiting in exam room, time spent with provider, and time-checked out, were all recorded. Similar time points were recorded for matched control patients that did not undergo telemedicine pre-screening and were seen in the traditional manner. Inclusion criteria included: being brand new to the practice and unilateral knee pain. Results: There were eight pre-screened patients and ten control patients in this cohort. Compared to controls, pre-screened patients spent less time in the exam room (19 min vs. 31 min), higher percentage of the exam room time with the provider (58% vs. 34%), higher percentage of the overall visit time with the provider (29% vs. 19.5%), and less time for the overall visit (39 min vs. 52 min). Conclusion: Pre-screening patients to obtain background information can decrease exam room waiting time and overall visit time and maximize time during the visit spent with the provider. In addition, it could potentially be used to increase throughput through the clinic and improve patient satisfaction scores.

Comparison of Validity of Mapping between Drug Indications and ICD-10

2014 ◽  
Vol 53 (03) ◽  
pp. 195-201 ◽  
Author(s):  
Y. Choi ◽  
C. Jung ◽  
Y. Chae ◽  
M. Kang ◽  
J. Kim ◽  
...  
Keyword(s):  
Gold Standard ◽  
Kappa Statistic ◽  
Direct Approach ◽  
Free Text ◽  
Good Opportunity ◽  
Mapping Approach ◽  
Icd 10 ◽  
Standard Terminology ◽  
The Mean ◽  
Experienced Nurse

SummaryBackground: Mapping of drug indications to ICD-10 was undertaken in Korea by a public and a private institution for their own purposes. A different mapping approach was used by each institution, which presented a good opportunity to compare the validity of the two approaches.Objectives: This study was undertaken to compare the validity of a direct mapping approach and an indirect terminology based mapping approach of drug indications against the gold standard drawn from the results of the two mapping processes.Methods: Three hundred and seventy-five cardiovascular reference drugs were selected from all listed cardiovascular drugs for the study. In the direct approach, two experienced nurse coders mapped the free text indications directly to ICD-10. In the indirect terminology based approach, the indications were extracted and coded in the Korean Standard Terminology of Medicine. These terminology coded indications were then manually mapped to ICD-10. The results of the two approaches were compared to the gold standard. A kappa statistic was calculated to see the compatibility of both mapping approaches. Recall, precision and F1 score of each mapping approach were calculated and analyzed using a paired t-test.Results: The mean number of indications for the study drugs was 5.42. The mean number of ICD-10 codes that matched in direct approach was 46.32 and that of indirect terminology based approach was 56.94. The agreement of the mapping results between the two approaches were poor (kappa = 0.19). The indirect terminology based approach showed higher recall (86.78%) than direct approach (p < 0.001). However, there was no difference in precision and F1 score between the two approaches.Conclusions: Considering no differences in the F1 scores, both approaches may be used in practice for mapping drug indications to ICD-10. However, in terms of consistency, time and manpower, better results are expected from the indirect terminology based approach.

Rasch development and validation of a new faces scale for measuring pain, and its comparison with a gold standard: the Balparda–Herrera Pain Scale

2021 ◽  
Author(s):  
Kepa Balparda ◽  
Tatiana Herrera-Chalarca ◽  
Melissa Cano-Bustamante ◽  
Tatiana Gómez-González ◽  
María Alejandra Nicholls-Molina
Keyword(s):  
Gold Standard ◽  
Statistical Tests ◽  
Adult Population ◽  
Pain Scale ◽  
Rasch Modeling ◽  
Final Version ◽  
Pain Scales ◽  
Development And Validation

Aim: Faces pain scales are widely used to measure pain. So far, no faces pain scale has ever been constructed by Rasch modeling. Hence the authors aimed to construct a new scale by this method. Methods: Rasch modeling was used to provide an initial calibration and development of the ‘Balparda–Herrera Pain Scale’ (BHPS) and this scale was compared with the existing Faces Pain Scale – Revised. The scale was later refined. Results: Both the existing scale and the initial version of the BHPS required category collapsing. Statistical tests demonstrated an excellent concordance between both scales. The final version of the BHPS was found to behave excellently and to be capable of adequately measuring pain. Conclusion: The BHPS provides an excellent instrument for measuring pain in the adult population.

Evaluating the ARF diagnosis calculator: A survey and content analysis. (Preprint)

2021 ◽  
Author(s):  
Elizabeth Fisher ◽  
Christian James ◽  
Diana Mosca ◽  
Bart J Currie ◽  
Anna P Ralph
Keyword(s):  
Health Service ◽  
Test Performance ◽  
Gold Standard ◽  
Online Survey ◽  
Clinical Laboratory ◽  
Diagnostic Process ◽  
Reference Ranges ◽  
Clinical Expertise ◽  
Structured Interviews ◽  
Support Tool

BACKGROUND Acute Rheumatic Fever (ARF) is a critically important condition for which there is no diagnostic test. Diagnosis requires the use of a set of criteria comprising clinical, laboratory, electrocardiographic and echocardiographic findings. The complexity of the algorithm and the fact that clinicians lack familiarity with ARF, make ARF diagnosis ideally suited to an electronic decision support tool. We developed an ARF Diagnosis Calculator to assist clinicians in diagnosing ARF and correctly assigning categories of ‘possible, ‘probable’ or ‘definite’ ARF. OBJECTIVE To evaluate the acceptability and accuracy of the ARF Diagnosis Calculator as perceived by clinicians in Northern Australia where ARF rates are high, and test performance against a ‘gold standard’. METHODS Three strategies were used to provide triangulation of data. Users of the calculator employed at Top End Health Service, Northern Territory, Australia were invited to participate in an online survey about the calculator, and clinicians with ARF expertise were invited to participate in semi-structured interviews. Qualitative data were analysed using inductive analysis. Performance of the calculator in correctly assigning a diagnosis of possible, probable or definite ARF, or not ARF, was assessed using clinical data from 35 patients presenting with suspected ARF. Diagnoses obtained from the calculator were compared using the Kappa statistic with those obtained from a panel of expert clinicians, considered the ‘gold standard’. Findings were shared with developers of the calculator and changes were incorporated. RESULTS Survey responses were available from 23 Top End Health Service medical practitioners, and interview data were available from five expert clinicians. Using a 6-point Likert scale, participants highly recommended the ARF Diagnosis Calculator (median score 6, IQR 1) and found it easy to use (median 5, IQR 1). Participants believed the calculator helped them diagnose ARF (median 5, IQR 1). Valued features included educational content and laboratory test reference ranges. Criticisms included: too many pop-up messages to be clicked through; that it is less helpful in remote areas which lack access to investigation results; and the need for more clarity about actively excluding alternative diagnoses to avoid false-positive ARF diagnoses. Importantly, clinicians with ARF expertise noted that electronic decision making is not a substitute for clinical experience. There was high agreement between the ARF Diagnosis Calculator and the ‘gold standard’ ARF diagnostic process (κ=0.767, 95% CI: 0.568-0.967). However, incorrect assignment of diagnosis occurred in 4/35 (11%) patients highlighting the greater accuracy of expert clinical input for ambiguous presentations. Sixteen changes were incorporated into a revised version of the calculator. CONCLUSIONS The ARF Diagnosis Calculator is an easy-to-use, accessible tool, but it does not replace clinical expertise. Effective resources to support clinicians in diagnosing and managing ARF are critically important for improving the quality of care of ARF.

scholarly journals Sesame, Pistachio, and Macadamia Nut: Development and Validation of New Allergenic Systems for Fast Real-Time PCR Application

Foods ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 1085
Author(s):  
Martina Torricelli ◽  
Elisa Pierboni ◽  
Cristina Rondini ◽  
Serena Altissimi ◽  
Naceur Haouet
Keyword(s):  
Real Time ◽  
Real Time Pcr ◽  
Food Processing ◽  
Annealing Temperature ◽  
Limit Of Detection ◽  
Food Samples ◽  
Support Tool ◽  
Macadamia Nut ◽  
Real Market ◽  
Development And Validation

Food allergy is a worldwide health problem that concerns infants to adults. The main health risk for sensitised individuals is due to the presence of traces of allergens as the result of an accidental contamination during food processing. The labelling of allergens such as sesame, pistachio, and macadamia nut on food products is mandatory according to Regulation (EU) N. 1169/2011; therefore, the development of suitable and specific analytical methodologies is advisable. The aim of this study was to perform a multi-allergen real-time PCR system that works well in fast mode at the same annealing temperature and with the same thermal profile. The real-time PCR was developed designing new, specific, and efficient primer and probe systems for the 2S albumingene for sesame and pistachio and for the vicilin precursorgene for macadamia nut. These systems were subjected to a robust intra-laboratory qualitative validation process prior to their application, by DNA extraction and fast real-time PCR, on some real market samples to reproduce a potential allergen contamination along the food chain. The developed system results were specific and robust, with a sensible limit of detection (0.005% for sesame; 0.004% for pistachio; 0.006% for macadamia nut). The performance and the reliability of the target systems were confirmed on commercial food samples. This molecular approach could be used as a screening or as a support tool, in association with the other widespread monitoring techniques (such as ELISA).

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