Guideline adherence for diagnosis of liver cancer in veterans.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 89-89 ◽  
Author(s):  
Yvonne Sada ◽  
Eric David ◽  
Hashem El-Serag ◽  
Hardeep Singh ◽  
Jessica Davila
Keyword(s):  
Median Time ◽  
Guideline Adherence ◽  
Gold Standard ◽  
Diagnostic Delay ◽  
Standard Test ◽  
Diagnostic Process ◽  
Liver Mass ◽  
Missed Appointments ◽  
Gold Standard Test ◽  
Work Up

89 Background: The incidence of hepatocellular cancer (HCC) is rising. Practice guidelines provide the recommended approach for HCC diagnosis, but adherence to diagnostic guidelines is unknown. Methods: In a national sample of veterans with confirmed HCC, we performed a retrospective chart review of patients with cirrhosis and a new liver mass on imaging between 2005 and 2011. Clinical data was used to assess adherence to American Association for the Study of Liver Diseases guidelines. Patients with inadequate data to assess guideline adherence (missing liver mass size, imaging technique, or diagnostic report) were excluded. We identified factors that contributed to guideline non-adherence. Initial liver mass date was the first date a liver mass was reported on imaging (CT, MRI, or ultrasound). Gold standard test date was the date a diagnosis of HCC could have been made by guideline recommended testing and criteria. Diagnosis date was the date a provider documented the diagnosis. Results: We reviewed charts for 380 patients. Overutilization of diagnostic tests after a gold standard test occurred in 112 patients (31%), and 17 (4%) had insufficient tests. Guidelines were not followed in 124 (33%). Of these 124, 68 (55%) had liver masses that increased in size during diagnostic work-up. The most common factors associated with guideline non-adherence were unnecessary testing such as biopsy after a gold standard image (43%) and the presence of a contraindication to a guideline recommended image or biopsy (12%). Patient factors (missed appointments, declining work-up) accounted for only 3% of cases. Median time between the initial liver mass and gold standard test was 15 days (IQR: 0-99). Median time between the initial liver mass and diagnosis was 50 days (IQR: 12-191). Most diagnoses were made by gastroenterology (51%), followed by primary care (19%), and oncology (10%). Conclusions: One-third of patients with HCC were not diagnosed based on guidelines. These concerns include confidence in diagnosis (lack of recognizing HCC diagnosis despite gold standard evidence) and over testing, which both lead to diagnostic delay. Our findings warrant further evaluation of contributory factors to develop interventions that improve the diagnostic process for HCC.

The Clinical Evaluation: A Necessary Tool for the Dysphagia Sleuth

2015 ◽  
Vol 24 (1) ◽  
pp. 18-25 ◽  
Author(s):  
James L. Coyle
Keyword(s):  
Gold Standard ◽  
Clinical Problem ◽  
Standard Test ◽  
Diagnostic Process ◽  
Comprehensive Treatment ◽  
Short Term ◽  
Speech Language Pathologist ◽  
Gold Standard Test ◽  
Very High ◽  
Health Experts

There is controversy about the necessity of clinical (bedside) swallowing examinations. Some argue that screening provides enough information to thoroughly manage a case. In instances in which the risk of an adverse event is very high, screening legitimizes short-term intervention to temporarily mitigate that risk. But comprehensive treatment based on screening is always an unguided and imprecise strategy because screening cannot identify the nature of the problem or the method that best treats the problem. As physicians and public health experts know, the diagnostic process begins with case-finding procedures that predict the presence of risk, and progresses through increasingly precise methods until the clinical problem is resolved. Sometimes the more costly gold standard examination is unnecessary. And sometimes the gold standard test is unavailable because the patient is seen in a system in which the infrastructure and expertise for conducting diagnostic instrumental testing are inaccessible, or because of wait lists, or funding issues. Such situations require the speech-language-pathologist (SLP) to determine how to gather the most and best information available under these constraints. This article will discuss the clinical examinations' role in the diagnostic process and refute the claim that it is unnecessary.

scholarly journals Prevalence of feline coronavirus antibodies in cats in Bursa province, Turkey, by an enzyme-linked immunosorbent assay

2009 ◽  
Vol 11 (10) ◽  
pp. 881-884 ◽  
Author(s):  
Annamaria Pratelli ◽  
Kadir Yesilbag ◽  
Marcello Siniscalchi ◽  
Ebru Yalçm ◽  
Zeki Yilmaz
Keyword(s):  
Immunosorbent Assay ◽  
Predictive Value ◽  
Gold Standard ◽  
Population Based ◽  
Standard Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
Serum Samples ◽  
High Association ◽  
Gold Standard Test ◽  
Feline Coronavirus

Feline sera from Bursa province (Turkey) were assayed for coronavirus antibody using an enzyme-linked immunosorbent assay (ELISA). The study was performed on 100 sera collected from cats belonging to catteries or community shelters and to households. The serum samples were initially tested with the virus neutralisation (VN) test and the results were then compared with the ELISA. The VN yielded 79 negative and 21 positive sera but the ELISA confirmed only 74 as negative. The ELISA-negative sera were also found to be free of feline coronoviruses-specific antibodies by Western blotting. Using the VN as the gold standard test, ELISA had a sensitivity of 100% and a specificity of 93.6%, with an overall agreement of 95%. The Kappa (κ) test indicated high association between the two tests (κ=0.86, 95% confidence interval (CI) 0.743–0.980). The positive predictive value (PPV) was 0.8, and the negative predictive value (NPV) was 0.93. The prevalence of FCoV II antibodies in the sampled population based on the gold standard was 62% (95% CI 0.44–0.77) among multi-cat environments, and 4% (95% CI 0.01–0.11) among single cat households.

scholarly journals To evaluate the diagnostic value of protein: creatinine ratio in a single voided urine sample for quantitation of proteinuria compared to those of a 24-hour urine sample in patients with preeclampsia

2014 ◽  
Vol 9 (2) ◽  
pp. 45-53
Author(s):  
S Hossain ◽  
A Ghosh ◽  
A Chatterjee ◽  
G Sarkar ◽  
SS Mondal
Keyword(s):  
Urine Sample ◽  
Gold Standard ◽  
Diagnostic Value ◽  
Standard Test ◽  
Creatinine Ratio ◽  
Urine Protein ◽  
Predictive Values ◽  
Urine Protein Excretion ◽  
Protein Excretion ◽  
Gold Standard Test

Objective: This study was done to evaluate the diagnostic value of protein: creatinine ratio in a single voided urine sample for quantitation of proteinuria compared to those of a 24 hour urine sample in patients with preeclampsia. Methods: A prospective simple random sample study was done on the hypertensive pregnant women attending the antenatal clinic or admitted in Department of Obstetrics and Gynaecology. It included all women being evaluated for preeclampsia, regardless of the alerting sign or symptom, suspected severity or co-morbid conditions. The main measures were the urinary protein to urinary creatinine ratio by random (spot) direct measurement and the 24-h urinary protein excretion by a 24-h urine collection. The data obtained was statistically analyzed. Results: Out of the 78 patients with gestational hypertension included in our study 48 patients had significant proteinuria (e”300mg/day). Only 2 patients had proteinuria of the range of greater than 3500mg. Among the patients, 50 had a positive protein: creatinine ratio (e”0.3) while 28 patients had a negative protein: creatinine ratio (<0.3). The P: C ratio was able to correctly identify 44 out of 48 patients with significant proteinuria (when the comparison is made with the gold-standard test; i.e., 24-hour urine protein). It could also identify 24 out of 30 patients without significant proteinuria as compared to the gold-standard test. In this study, the Protein: Creatinine ratio with a sensitivity of 91.67%, a specificity of 80%, positive predictive values 88% and the negative predictive values 85.71%. Conclusions: Our data suggests that the protein: creatinine ratio in single voided urine is a highly accurate test (p value < 0.0000001) for discriminating between insignificant and significant proteinuria. Based on the above findings we conclude that a random urine protein excretion predicts the amount of 24- hour urine protein excretion with high accuracy. This could be a reasonable alternative to the 24-hour urine collection for detection of significant proteinuria in hospitalised pregnant women with suspected preeclampsia. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 45-53 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9687

scholarly journals Partial clinical remission in type 1 diabetes: a comparison of the accuracy of total daily dose of insulin of <0.3 units/kg/day to the gold standard insulin-dose adjusted hemoglobin A1c of ≤9 for the detection of partial clinical remission

2017 ◽  
Vol 30 (8) ◽  
Author(s):  
Rachel L. Lundberg ◽  
Katherine R. Marino ◽  
Aastha Jasrotia ◽  
Louise S. Maranda ◽  
Bruce A. Barton ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Gold Standard ◽  
Clinical Remission ◽  
Insulin Dose ◽  
Standard Test ◽  
Total Daily Dose ◽  
Gold Standard Test ◽  
Daily Dose ◽  
New Onset

AbstractBackground:It is unclear whether the gold standard test for the detection of partial clinical remission (PCR) in new-onset type 1 diabetes (T1D), the insulin-dose adjusted Hemoglobin AMethods:A retrospective analysis of 204 subjects of ages 2–14 years, mean age 7.9±3.2 years, (male 7.8±3.4 years, [n=98]; female 7.9±3.0 years, [n=106], p=0.816) with new-onset T1D. Anthropometric and biochemical data were collected for the first 36 months of disease. PCR was defined by both IDAAResults:There were 86 (42.2%) (age 9.1±3.0 years; male 57%) remitters by IDAAConclusions:There were no significant differences in the number of remitters, duration of PCR, or the time of peak remission defined by IDAA

scholarly journals Computed tomography scan can be misleading in the lateralisation of aldosterone excess

2019 ◽  
Vol 2019 ◽  
Author(s):  
G Leksic ◽  
A M Alduk ◽  
V Molnar ◽  
A Haxhiu ◽  
A Haxhiu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Gold Standard ◽  
Secondary Hypertension ◽  
Standard Test ◽  
List Type ◽  
Gold Standard Test ◽  
Unilateral Disease ◽  
Bilateral Adrenal Hyperplasia ◽  
Aldosterone Producing Adenoma ◽  
Unreliable Method

Summary Primary aldosteronism (PA) is characterised by aldosterone hypersecretion and represents a common cause of secondary hypertension. During diagnostic evaluation, it is essential to determine the aetiology of PA since the treatment of unilateral and bilateral disease differs significantly. Adrenal vein sampling (AVS) has been implemented as a gold standard test for the diagnosis of PA subtype. However, due to the AVS complexity, costs and limited availability, many patients with PA are being treated based on the computed tomography (CT) findings. In this article, we present two patients with discrepant CT and AVS results, demonstrating that AVS is the only reliable method for localising the source of aldosterone excess. Learning points: CT is an unreliable method for distinguishing aldosterone-producing adenoma (APA) from bilateral adrenal hyperplasia (BAH). CT can be misleading in defining lateralisation of the aldosterone excess in case of unilateral disease (APA). AVS is the gold standard test for defining the PA subtype.

scholarly journals Evidence about the Chest CT diagnostic performance in the pandemic of SARS-CoV-2 infection: A smooth takeoff and hard landing.

2020 ◽  
pp. 2-2
Keyword(s):  
Gold Standard ◽  
Large Scale ◽  
Clinical Decision Making ◽  
Standard Test ◽  
Chest Ct ◽  
Radiology Department ◽  
Rt Pcr ◽  
Likelihood Ratios ◽  
Pulmonary Lesions ◽  
Gold Standard Test

According to all guidelines, the unique criterion for the diagnosis of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the viral nucleic acid test by reverse transcription polymerase chain reaction (RT-PCR). That should always guide the isolation decision and the management conduction [1]. SARS-CoV-2 related pneumonia may manifest after 2 to 4 days following the coronavirus infection. Typical computed tomography (CT) feature of coronavirus (COVID-19) lung disease is the bilateral , peripheric or diffuse and patchy ground-glass opacities(GGO) with consolidations. Several other signs such as crazy paving pattern , interstitial thickening, reversed-halo or microvascular embolisms are less likely described and may evoke COVID-19 pneumonia in an appropriate context. The chest CT could be initially normal. The GGO have tendency of quick evolution till the seventh day and stabilize later till the 20th day of the COVID-19 infection. Lung lesions in severe cases involve more lung segments with larger sized GGO. the interlobular septal thickening and consolidations are constant. The pleural effusion and pneumothorax were rarely described [2]. The lack of sensitivity, insufficient stability, and relatively long processing time of RT-PCR gave a considerable place for the chest CT in the daily practice of COVID-19 patients. Several reports found exciting the confrontation between the CT and the RT-PCR results. The sensitivity of CT features in highly pandemic areas could reach 97%. The earlier CT chest signs and the improvement of pulmonary lesions before RT-PCR negativity made some authors recommend the CT chest as diagnostic screening tool [3-5]. However, we still believe that the recommendation of the CT as a new diagnostic tool could not be based only on likelihood ratios and temporary concordance with the reference gold standard test. The respect of the basic epidemiologic principles is always mandatory to enhance the conclusion’s value. These recommendations were not born from blinded comparison with the refence test such in controlled randomized trials. To avoid time-lead bias many studies did not consider other potential bias especially the confusion and the selection. Moreover, the CT result did not influence the decision of proceeding to the reference test in all the previous reports. In this pandemic era, a chest CT examination will include not only additional cost for personal protective equipment (PPE) and sterilization but also more risk for the radiology department staff [6]. The chest CT could be used to select patients candidate for RT-PCR. Its value in the management and the follow up of pulmonary lesions cannot be overstated. It could play a role in clinical decision making when the gold standard test is not available in highly pandemic areas. Most of the radiology societies all over the world were not recommending the CT as diagnostic test especially in large scale screening. The few metaanalysis available have discordant conclusions about the topic. Upcoming evidence-based reports should contribute more to that [7,8].

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