scholarly journals A registry-based observational study comparing emergency calls assessed by emergency medical dispatchers with and without support by registered nurses

2022 ◽  
Vol 30 (1) ◽  
Author(s):  
Klara Torlén Wennlund ◽  
Lisa Kurland ◽  
Knut Olanders ◽  
Maaret Castrén ◽  
Katarina Bohm
Keyword(s):  
Observational Study ◽  
Formal Education ◽  
Medical Condition ◽  
Future Research ◽  
Predictive Values ◽  
Priority Level ◽  
Emergency Medical ◽  
Emergency Medical Dispatcher ◽  
Sensitivity Specificity ◽  
Emergency Medical Dispatching

Abstract Background The requirement concerning formal education for emergency medical dispatcher (EMD) is debated and varies, both nationally and internationally. There are few studies on the outcomes of emergency medical dispatching in relation to professional background. This study aimed to compare calls handled by an EMD with and without support by a registered nurse (RN), with respect to priority level, accuracy, and medical condition. Methods A retrospective observational study, performed on registry data from specific regions during 2015. The ambulance personnel’s first assessment of the priority level and medical condition was used as the reference standard. Outcomes were: the proportion of calls dispatched with a priority in concordance with the ambulance personnel’s assessment; over- and undertriage; the proportion of most adverse over- and undertriage; sensitivity, specificity and predictive values for each of the ambulance priorities; proportion of calls dispatched with a medical condition in concordance with the ambulance personnel’s assessment. Proportions were reported with 95% confidence intervals. χ2-test was used for comparisons. P-levels < 0.05 were regarded as significant. Results A total of 25,025 calls were included (EMD n = 23,723, EMD + RN n = 1302). Analyses relating to priority and medical condition were performed on 23,503 and 21,881 calls, respectively. A dispatched priority in concordance with the ambulance personnel’s assessment were: EMD n = 11,319 (50.7%) and EMD + RN n = 481 (41.5%) (p < 0.01). The proportion of overtriage was equal for both groups: EMD n = 5904, EMD + RN n = 306, (26.4%) p = 0.25). The proportion of undertriage for each group was: EMD n = 5122 (22.9%) and EMD + RN n = 371 (32.0%) (p < 0.01). Sensitivity for the most urgent priority was 54.6% for EMD, compared to 29.6% for EMD + RN (p < 0.01), and specificity was 67.3% and 84.8% (p < 0.01) respectively. A dispatched medical condition in concordance with the ambulance personnel’s assessment were: EMD n = 13,785 (66.4%) and EMD + RN n = 697 (62.2%) (p = 0.01). Conclusions A higher precision of emergency medical dispatching was not observed when the EMD was supported by an RN. How patient safety is affected by the observed divergence in dispatched priorities is an area for future research.

scholarly journals How accurate is the prehospital diagnosis of hyperventilation syndrome?

2020 ◽  
Vol 12 (11) ◽  
pp. 445-454
Author(s):  
Caitlin Wilson ◽  
Clare Harley ◽  
Stephanie Steels
Keyword(s):  
Routine Data ◽  
Emergency Medical Technicians ◽  
Likelihood Ratios ◽  
Hyperventilation Syndrome ◽  
Predictive Values ◽  
Emergency Medical ◽  
Retrospective Audit ◽  
Emergency Ambulance ◽  
The Uk ◽  
Sensitivity Specificity

Background: The literature suggests that hyperventilation syndrome (HVS) should be diagnosed and treated prehospitally. Aim: To determine diagnostic accuracy of HVS by paramedics and emergency medical technicians using hospital doctors' diagnosis as the reference standard. Methods: A retrospective audit was carried out of routine data using linked prehospital and in-hospital patient records of adult patients (≥18 years) transported via emergency ambulance to two emergency departments in the UK from 1 January 2012–31 December 2013. Accuracy was measured using sensitivity, specificity, positive and negative predictive values (NPV/PPVs) and likelihood ratios (LRs) with 95% confidence intervals. Results: A total of 19 386 records were included in the analysis. Prehospital clinicians had a sensitivity of 88% (95% CI [82–92%]) and a specificity of 99% (95% CI [99–99%]) for diagnosing HVS, with PPV 0.42 (0.37, 0.47), NPV 1.00 (1.00, 1.00), LR+ 75.2 (65.3, 86.5) and LR− 0.12 (0.08, 0.18). Conclusions: Paramedics and emergency medical technicians are able to diagnose HVS prehospitally with almost perfect specificity and good sensitivity.

scholarly journals Monofrequency electrical impedance mammography (EIM) diagnostic system in breast cancer screening

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Blanca Murillo-Ortiz ◽  
Abraham Hernández-Ramírez ◽  
Talia Rivera-Villanueva ◽  
David Suárez-García ◽  
Mario Murguía-Pérez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Electrical Impedance ◽  
Screening Method ◽  
Future Research ◽  
Predictive Values ◽  
Sensitivity Specificity

Abstract Background Some evidence has shown that malignant breast tumours have lower electrical impedance than surrounding normal tissues. Electrical impedance could be used as an indicator for breast cancer detection. The purpose of our study was to analyse the sensitivity and specificity of electrical impedance mammography (EIM) and its implementation for the differential diagnosis of pathological lesions of the breast, either alone or in combination with mammography/ultrasound, in 1200 women between 25 and 70 years old. Methods This study is a prospective, cross-sectional epidemiological observational study of serial screening. The women were invited to participate and signed a consent letter. Impedance imaging of the mammary gland was evaluated with the computerized mammography equipment of MEIK electroimpedance v.5.6. (0.5 mA, 50 kHz), developed and manufactured by PKF SIM-Technika®. The successful identification of breast cancer along with the sensitivity, specificity, and positive and negative predictive values of EIM were determined as follows: % sensitivity; % specificity; % positive predictive value (PPV); and % negative predictive value (NPV). Results EIM had a sensitivity of 85% and a specificity of 96%; the positive predictive value was 12%, and the negative predictive value was 99%. Seven cases were biopsy confirmed cancers. Significant correlations between the electrical conductivity index and body mass index (BMI) (p = 0.04) and patient age were observed (p = 0.01). We also observed that the average conductivity distribution increased according to age group (p = 0.001). We used the chi-squared test to assess the interactions between percent density and BMI (normal < 25 kg/m2 (n = 310), overweight 25–29.9 kg/m2 (n = 418) and obese ≥30 (n = 437)) (p <  0.05). The patients with a diagnosis of mammary carcinoma had a BMI of 35.51 kg/m2. Conclusions Our results demonstrate that the use of monofrequency electrical impedance mammography (EIM) in the detection of breast cancer had a sensitivity and specificity of 85 and 96%, respectively. These findings may support future research in the early detection of breast cancer. EIM is a non-radiation method that may also be used as a screening method for young women with dense breasts and a high risk of developing breast cancer.

scholarly journals Serum Angiopoietin-1/Angiopoietin-2 at 16-18 Weeks of Gestation to Predict Preeclampsia

2021 ◽  
Author(s):  
Vorapong Phupong ◽  
Patau Tanbirojn ◽  
Ruangsak Lertkhachonsuk
Keyword(s):  
Observational Study ◽  
Positive Predictive Value ◽  
Pregnant Women ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Predictive Values ◽  
Early Onset Preeclampsia ◽  
Angiopoietin 2 ◽  
Sensitivity Specificity ◽  
Angiopoietin 1

Objective: To determine whether serum angiopoietin-1/angiopoietin-2 ratio can predict preeclampsia in women at 16–18 weeks of gestation, or not.Material and Methods: This was a prospective observational study that was conducted in pregnant women with gestational age of 16-18 weeks. Serum angiopoietin-1 and angiopoietin-2 levels were acquired. The predictive values of these tests were calculated.Results: Data from 269 pregnant women were analyzed. Twenty-two cases developed preeclampsia, and five of these cases had early onset preeclampsia. When the angiopoietin-1/angiopoietin-2 ratio was above 6.2, the sensitivity, specificity, positive predictive value and negative predictive values to predict preeclampsia were 50.0%, 72.9%, 14.1% and 94.2%, respectively. When angiopoietin-1 was used to predict preeclampsia, the sensitivity, specificity, positive predictive value and negative predictive values were 59.1%, 65.2%, 13.1% and 94.7%, respectively. When angiopoietin-2 was used to predict preeclampsia, the sensitivity, specificity, positive predictive value and negative predictive values were 63.6%, 50.2%, 10.2% and 93.9%, respectively.Conclusion: This study demonstrated that serum angiopoietin-1/angiopoietin-2 ratio at 16-18 weeks of gestation was not effective in predicting preeclampsia. However, angiopoietin-2 may be used to predict preeclampsia.

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 Recommendation Systems for Education: Systematic Review

Electronics ◽  
2021 ◽  
Vol 10 (14) ◽  
pp. 1611
Author(s):  
María Cora Urdaneta-Ponte ◽  
Amaia Mendez-Zorrilla ◽  
Ibon Oleagordia-Ruiz
Keyword(s):  
Machine Learning ◽  
Systematic Review ◽  
Formal Education ◽  
Research Work ◽  
Hybrid Approach ◽  
Recommendation Systems ◽  
Educational Resources ◽  
Future Research ◽  
Collaborative Approach ◽  
Developmental Approach

Recommendation systems have emerged as a response to overload in terms of increased amounts of information online, which has become a problem for users regarding the time spent on their search and the amount of information retrieved by it. In the field of recommendation systems in education, the relevance of recommended educational resources will improve the student’s learning process, and hence the importance of being able to suitably and reliably ensure relevant, useful information. The purpose of this systematic review is to analyze the work undertaken on recommendation systems that support educational practices with a view to acquiring information related to the type of education and areas dealt with, the developmental approach used, and the elements recommended, as well as being able to detect any gaps in this area for future research work. A systematic review was carried out that included 98 articles from a total of 2937 found in main databases (IEEE, ACM, Scopus and WoS), about which it was able to be established that most are geared towards recommending educational resources for users of formal education, in which the main approaches used in recommendation systems are the collaborative approach, the content-based approach, and the hybrid approach, with a tendency to use machine learning in the last two years. Finally, possible future areas of research and development in this field are presented.

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.

scholarly journals Accuracy of the fluorescence-aided identification technique (FIT) for detecting tooth-colored restorations utilizing different fluorescence-inducing devices: an ex vivo comparative study

2021 ◽  
Author(s):  
W. Leontiev ◽  
E. Magni ◽  
C. Dettwiler ◽  
C. Meller ◽  
R. Weiger ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ex Vivo ◽  
Predictive Values ◽  
Composite Restorations ◽  
Significant Difference ◽  
Identification Technique ◽  
Illumination Method ◽  
Sensitivity Specificity ◽  
Entire Procedure ◽  
Higher Sensitivity

Abstract Objectives The aim of the present study was to compare the accuracy of the conventional illumination method (CONV) and the fluorescence-aided identification technique (FIT) for distinguishing between composite restorations and intact teeth using different fluorescence-inducing devices commonly used for FIT. Materials and methods Six groups of six dentists equipped with one of six different FIT systems each independently attempted to identify composite restorations and intact teeth on a full-mouth model with 22 composite restorations using CONV and, 1 h later, FIT. The entire procedure was repeated 1 week later. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values, including 95% confidence intervals (CI), were calculated for CONV and FIT overall and for each device. The influence of examiner age, method, and device on each parameter was assessed by multivariate analysis of variance. Results The sensitivity (84%, CI 81–86%), specificity (94%, CI 93–96%), PPV (92%, CI 90–94%), and NPV (90%, CI 88–91%) of FIT was significantly higher than that of CONV (47%, CI 44–50%; 82%, CI 79–84%; 66%, CI 62–69%, and 69%, CI 68–71%, respectively; p<0.001). The differences between CONV and FIT were significant for all parameters and FIT systems except VistaCam, which achieved no significant difference in specificity. Examiners younger than 40 years attained significantly higher sensitivity and negative predictive values than older examiners. Conclusions FIT is more reliable for detecting composite restorations than the conventional illumination method. Clinical relevance FIT can be considered an additional or alternative tool for improving the detection of composite restorations.

Sign in / Sign up

Export Citation Format

Share Document