scholarly journals Lung sonography is useful for the initial detection of left-sided double lumen tracheal tube position in both novice and expert; a randomized prospective crossover study

2019 ◽  
Author(s):  
Hyungseok Seo ◽  
YoonJu Go ◽  
Yong Seok Jang ◽  
Bong-Jae Lee
Keyword(s):  
Double Lumen Tube ◽  
Characteristic Analysis ◽  
Double Lumen ◽  
Diagnostic Efficacy ◽  
Predictive Values ◽  
Lung Sonography ◽  
Chest Auscultation ◽  
Novices And Experts ◽  
Sensitivity Specificity

Abstract Background Detecting the position of the double lumen tube (DLT), lung sonography, can be an effective technique and may provide more detailed information than chest auscultation. However, the diagnostic efficacy of lung sonography for determining DLT position can differ between novice and expert.Methods We enrolled and allocated ninety patients into two groups; one group using chest auscultation and the other using lung sonography for the determination of DLT position. In both groups, two repeat-assessments were provided by two independent examiners; first by a novice, and second by an expert. The primary outcome was the overall accuracy, sensitivity, specificity, positive or negative predictive values between novice and expert in confirming the position of the left-sided DLT. In both groups, final position was confirmed by a fiberoptic bronchoscopy.Results Both using auscultation and sonography, novices and experts showed similar diagnostic efficacy. However, in patients using sonography, both novice and expert showed better outcomes than in patients using chest auscultation. In receiver operating characteristic analysis, lung sonography seemed to showe a better predictability in incorrect DLT position than chest auscultation, especially by experts.Conclusion Lung sonography showed a better diagnostic efficacy for detecting DLT position than chest auscultation. Furthermore, using lung sonography, novice investigator may perform similar assessment for identifying incorrect DLT position to expert.

scholarly journals Lung sonography can improve the specificity of determination of left-sided double-lumen tracheal tube position in both novices and experts: a randomised prospective study

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096436
Author(s):  
Jun-Young Chung ◽  
YoonJu Go ◽  
Yong Seok Jang ◽  
Bong-Jae Lee ◽  
Hyungseok Seo
Keyword(s):  
Area Under The Curve ◽  
Double Lumen Tube ◽  
Initial Assessment ◽  
Prospective Clinical Study ◽  
Double Lumen ◽  
Diagnostic Efficacy ◽  
Lumen Tube ◽  
Lung Sonography ◽  
Novices And Experts

Objective Lung sonography can be helpful to determine the position of a left-sided double-lumen tube (DLT). However, clinical experience is required for correct assessment. We investigated whether lung sonography can improve the diagnostic efficacy of determining the DLT position in novices and experts. Methods In this randomised prospective clinical study, 88 patients were allocated to two groups using auscultation or lung sonography for initial assessment of the DLT position. In each group, two repeated assessments were performed; the first was performed by a novice, and the second was performed by an expert. The final DLT position was confirmed by fibre-optic bronchoscopy. The primary outcome was the diagnostic efficacy (including overall accuracy, sensitivity, and specificity) in confirming the DLT position. Results In both the novices and experts, the specificity of determining the DLT position was significantly higher with lung sonography than auscultation (60.0% vs. 21.7% and 66.7% vs. 37.5%, respectively). Additionally, the predictability of an incorrect position was similar between the novices and experts using lung sonography (area under the curve of 0.665 and 0.690, respectively). Conclusions Lung sonography can improve the diagnostic efficacy of detecting an incorrect DLT position in both novices and experts.

scholarly journals Value and Diagnostic Efficacy of Fetal Morphology Assessment Using Ultrasound in A Poor-Resource Setting

Diagnostics ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 109 ◽  
Author(s):  
Ukweh ◽  
Ugbem ◽  
Okeke ◽  
Ekpo
Keyword(s):  
Predictive Value ◽  
Performance Metrics ◽  
Area Under The Curve ◽  
Youden Index ◽  
Likelihood Ratios ◽  
Diagnostic Efficacy ◽  
Predictive Values ◽  
Resource Setting ◽  
Post Test ◽  
Sensitivity Specificity

Background: Ultrasound is operator-dependent, and its value and efficacy in fetal morphology assessment in a low-resource setting is poorly understood. We assessed the value and efficacy of fetal morphology ultrasound assessment in a Nigerian setting. Materials and Methods: We surveyed fetal morphology ultrasound performed across five facilities and followed-up each fetus to ascertain the outcome. Fetuses were surveyed in the second trimester (18th–22nd weeks) using the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. Clinical and surgical reports were used as references to assess the diagnostic efficacy of ultrasound in livebirths, and autopsy reports to confirm anomalies in terminated pregnancies, spontaneous abortions, intrauterine fetal deaths, and still births. We calculated sensitivity, specificity, positive and negative predictive values, Area under the curve (AUC), Youden index, likelihood ratios, and post-test probabilities. Results: In total, 6520 fetuses of women aged 15–46 years (mean = 31.7 years) were surveyed. The overall sensitivity, specificity, and AUC were 77.1 (95% CI: 68–84.6), 99.5 (95% CI: 99.3–99.7), and 88.3 (95% CI: 83.7–92.2), respectively. Other performance metrics were: positive predictive value, 72.4 (95% CI: 64.7–79.0), negative predictive value, 99.6 (95% CI: 99.5–99.7), and Youden index (77.1%). Abnormality prevalence was 1.67% (95% CI: 1.37–2.01), and the positive and negative likelihood ratios were 254 (95% CI: 107.7–221.4) and 0.23 (95% CI: 0.16–0.33), respectively. The post-test probability for positive test was 72% (95% CI: 65–79). Conclusion: Fetal morphology assessment is valuable in a poor economics setting, however, the variation in the diagnostic efficacy across facilities and the limitations associated with the detection of circulatory system anomalies need to be addressed.

Simultaneous determination of cerebrospinal fluid oligoclonal bands and the "gamma-protein index" by agarose electrophoresis and densitometry.

1986 ◽  
Vol 32 (1) ◽  
pp. 84-87 ◽  
Author(s):  
C A French ◽  
R P Tracy ◽  
R A Rudick ◽  
A M Kraemer ◽  
D A Arvan
Keyword(s):  
Cerebrospinal Fluid ◽  
Gamma Globulin ◽  
Oligoclonal Bands ◽  
Laboratory Procedure ◽  
Predictive Values ◽  
Qualitative And Quantitative ◽  
Agarose Electrophoresis ◽  
Sensitivity Specificity ◽  
Single Laboratory

Abstract Oligoclonal bands were identified in electropherograms of cerebrospinal fluid, and the "gamma-protein index" was concurrently calculated from the same strip. For the index, an upper limit of normal of 0.66 was established. We compared results with the clinical diagnosis in 69 patients with multiple sclerosis and 48 control patients with other diseases. Sensitivity, specificity, and positive predictive values of 73%, 96%, and 96%, respectively, were obtained from the index. An abnormal index and the presence of oligoclonal bands combined increased the positive predictive value to 100%. This approach may allow adequate qualitative and quantitative assessment of gamma-globulin abnormalities in cerebrospinal fluid after a single laboratory procedure.

Efficacy of serum laminin measurement for diagnosis of fibrotic liver diseases.

1988 ◽  
Vol 34 (10) ◽  
pp. 2026-2030 ◽  
Author(s):  
J Kropf ◽  
A M Gressner ◽  
A Negwer
Keyword(s):  
Liver Diseases ◽  
Reference Population ◽  
Diagnostic Methods ◽  
Biochemical Tests ◽  
Diagnostic Efficacy ◽  
Fibrotic Liver ◽  
Predictive Values ◽  
Amino Terminal ◽  
Better Than

Abstract We examined the efficacy of laminin assay in serum for diagnosis of fibrotic liver diseases. Values for subjects with liver disease significantly (P less than 0.05) exceeded those for healthy subjects and patients with nonhepatic diseases. At a cutoff value of 1.45 kilo-units(arb.)/L (approximately 330 micrograms/L) and an assumed prevalence of fibrotic liver diseases of 0.5, positive and negative predictive values of the test were 0.97 and 0.83, respectively, for the comparison with a healthy reference population and 0.81 and 0.80 for nonhepatic diseased patients. Increases in laminin concentration were positively correlated with the extent of fibrotic transition of the liver. Discrimination between fibrotic and cirrhotic stages of chronic liver diseases by means of laminin assay was better than with the amino-terminal propeptide of type III procollagen. According to the criteria of diagnostic efficacy, we conclude that determination of laminin in serum improves the possibilities of clinical-chemical diagnosis of liver fibrosis and cirrhosis. However, as commonly true for other biochemical tests, determination of laminin cannot replace conventional diagnostic methods.

scholarly journals Validity, reliability and accuracy of oscillometric devices, compared with Doppler ultrasound, for determination of the Ankle Brachial Index: an integrative review

2014 ◽  
Vol 13 (1) ◽  
pp. 27-33
Author(s):  
Rita de Cassia Gengo e Silva ◽  
Vanessa Ferreira Amorim de Melo ◽  
Maria Aparecida de Medeiros Lima
Keyword(s):  
Health Services ◽  
Literature Review ◽  
Doppler Ultrasound ◽  
Conventional Method ◽  
Ankle Brachial Index ◽  
Integrative Review ◽  
Predictive Values ◽  
Methodological Procedures ◽  
Sensitivity Specificity

INTRODUCTION: The conventional method for measuring the ankle-brachial index (ABI) requires a vascular Doppler machine and a trained professional, which is a barrier to the examination becoming more widely adopted across health services. For this reason, the possibility of substituting Doppler monitors for other types of device has been investigated. The objective of this study was to assess the validity, reliability and accuracy of taking ABI measurement using oscillometric devices and compare them to vascular Doppler.METHODS: This is an integrative literature review of four articles.RESULTS: There was very little uniformity between the four studies in terms of ample populations or the methodological procedures used to measure systolic pressures. The results for sensitivity, specificity and positive and negative predictive values varied and so did measures of reliability.CONCLUSIONS: The results of these studies do not provide a basis from which conclusions can be drawn on the validity, reliability or accuracy of employing oscillometric devices as a substitute for Doppler for determination of ABI.

scholarly journals Usefulness of Four Different Echinococcus granulosus Recombinant Antigens for Serodiagnosis of Unilocular Hydatid Disease (UHD) and Postsurgical Follow-Up of Patients Treated for UHD

2007 ◽  
Vol 15 (1) ◽  
pp. 147-153 ◽  
Author(s):  
Ana Hernández-González ◽  
Antonio Muro ◽  
Inmaculada Barrera ◽  
Guillermo Ramos ◽  
Antonio Orduña ◽  
...  
Keyword(s):  
Echinococcus Granulosus ◽  
Hydatid Disease ◽  
Characteristic Analysis ◽  
Predictive Values ◽  
Recombinant Antigens ◽  
Hydatid Fluid ◽  
Clinical Laboratories ◽  
Specific Immunoglobulin

ABSTRACT Four different recombinant antigens derived from Echinococcus granulosus, designated B1t, B2t, E14t, and C317, were tested with enzyme-linked immunosorbent assays (ELISAs) for the detection of specific immunoglobulin G (IgG) in patients with unilocular hydatid disease (UHD). The results were compared to those obtained with hydatid fluid and were subjected to receiver operator characteristic analysis. The diagnostic performance of the above-listed proteins was defined with respect to their specificity, sensitivity, and predictive values (PV); the influence of cyst location; and usefulness in the follow-up of surgical treatment for UHD and in the determination of whether or not patients have been surgically cured of UHD. The best diagnostic results were obtained with the anti-B2t IgG ELISA, with 91.2% sensitivity, 93% specificity, and high positive and negative PV (89.4 and 94.2, respectively). In addition, this diagnostic tool proved to be useful for the follow-up of surgically treated UHD patients. The anti-B2t IgG ELISA may find an application in the serodiagnosis of UHD in clinical laboratories.

scholarly journals DIAGNOSTIC EFFICACY OF MODIFIED ALVARADO SCORE OVER GRADDED COMPRESSION ULTRASONOGRAPHY

2013 ◽  
Vol 03 (03) ◽  
pp. 105-108
Author(s):  
Caren Dsouza ◽  
John Martis ◽  
Vinay Vaidyanathan
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Preoperative Diagnosis ◽  
Iliac Fossa ◽  
Diagnostic Efficacy ◽  
Alvarado Score ◽  
Predictive Values ◽  
Modified Alvarado Score ◽  
Sensitivity Specificity ◽  
Compression Ultrasonography

Abstract Background: Acute appendicitis is one of the commonest surgical emergencies. Despite a life time cumulative risk of nearly 7% its diagnosis remains a challenge. The risks of two primary outcomes must be balanced in the management of presumed appendicitis: perforation and misdiagnosis.The rate of misdiagnosis in certain populations is as high as 40%. Diagnostic aids like modified Alvarado score and ultrasonography can dramatically reduce the negative appendicectomies. Methods:Data was collected from 60 patients with complains of right iliac fossa pain over a period of 9 months to our hospital. All patients were categorised using the Alvarado score and Graded compression ultrasonography was done. The preoperative and histological findings were compared with the preoperative diagnosis. The collected data was analysed with regards to various parameters like sensitivity, specificity, predictive values and diagnostic accuracy. Results:In our study of 60 patients, 56 patients underwent appendicectomy out of which a histological confirmation of appendicitis was obtained for 50 patients, giving a negative appendicectomy rate of 12%.By taking a cut-off point of 7 for the Modified Alvarado score, a sensitivity of 97.56%, specificity of 66.67%, positive predictive value (PPV) of 95.23%, negative predictive value (NPV) of 80% and accuracy of 87.2% were calculated. Using the cut-off point of 6, a sensitivity of 90% specificity of 50%, PPV of 69.23%, NPV of 80% and accuracy of 55.56% were obtained. The sensitivity, specificity, PPV, NPV and accuracy rate of ultrasonography was 92.15%, 88.9%, 97.19%, 66.7% and 85%, respectively. Conclusion:The presence of a modified Alvarado score > 7 was found to be a dependable aid in the preoperative diagnosis of acute appendicitis. In cases where the score was negative or equivocal, ultrasonography greatly helped in the diagnosis thereby reducing the incidence of negative appendicectomies.

scholarly journals Differentiation of the right versus left outflow tract ventricular arrhythmias using local activation time at the His bundle electrogram

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Won-Seok Choe ◽  
So-Ryoung Lee ◽  
Myung-Jin Cha ◽  
Eue-Keun Choi ◽  
Seil Oh
Keyword(s):  
Diagnostic Accuracy ◽  
Outflow Tract ◽  
Activation Time ◽  
Characteristic Analysis ◽  
Predictive Values ◽  
Cutoff Value ◽  
Local Activation ◽  
His Bundle ◽  
Sensitivity Specificity ◽  
Local Activation Time

Abstract Background Although multiple algorithms based on surface electrocardiographic criteria have been introduced to localize idiopathic ventricular arrhythmia (VA) origins from the outflow tract (OT), their diagnostic accuracy and clinical usefulness remain limited. We evaluated whether local activation time of the His bundle region could differentiate left and right ventricular OT VA origins in the early stage of electrophysiology study. Methods We studied 30 patients who underwent catheter ablation for OT VAs with a left bundle branch block pattern and inferior axis QRS morphology. The interval between the local V signal on the mapping catheter placed in the RVOT and His bundle region (V(RVOT)-V(HB) interval) and the interval from QRS complex onset to the local V signal on the His bundle region (QRS-V(HB) interval) were measured during VAs. Results The V(RVOT)-V(HB) and QRS-V(HB) intervals were significantly shorter in patients with LVOT VAs. The area under the curve (AUC) for the V(RVOT)-V(HB) interval by receiver operating characteristic analysis was 0.865. A cutoff value of ≤ 50 ms predicted an LVOT origin of VA with sensitivity, specificity, and positive and negative predictive values of 100%, 62.5%, 40%, and 100%, respectively. The QRS-V(HB) interval showed similar diagnostic accuracy (AUC, 0.840), and a cutoff value of ≤ 15 ms predicted an LVOT origin of VA with a sensitivity, specificity, and positive and negative predictive values of 100%, 70.8%, 45.2%, and 100%, respectively. Conclusion The V(RVOT)-V(HB) and QRS-V(HB) intervals could differentiate left from right OT origins of VA with high sensitivity and negative predictive values.

scholarly journals Comparison of Five Methods for the Determination of Rubella Immunity

1994 ◽  
Vol 1 (4) ◽  
pp. 188-192
Author(s):  
Robert L. Sautter ◽  
Arthur E. Crist ◽  
Lynn M. Johnson ◽  
William D. LeBar
Keyword(s):  
Medical Center ◽  
False Negative ◽  
Latex Agglutination ◽  
Walk Away ◽  
Becton Dickinson ◽  
Predictive Values ◽  
Research Triangle ◽  
System A ◽  
Sensitivity Specificity

Objective:The purpose of this study was to compare the accuracy of commonly used methods for the detection of rubella immunity, especially the fully automated IMx assay.Methods:A total of 190 sera (101 immune and 89 non-immune) submitted to Harrisburg Hospital or Polyclinic Medical Center for the determination of rubella immunity were tested by enzyme immunoassay (IMx and Rubazyme, Abbott Diagnostic Laboratories, North Chicago, IL), indirect immunofluorescence (FIAX, Whittaker Bioproducts, Walkersville, MD), and latex agglutination (Rubascan, Becton Dickinson Microbiology Systems, Cockeysville, MD, and Rubalex, Wellcome Diagnostics, Research Triangle Park, NC). Specimens were frozen at –30℃ until the study was initiated. Each of the assays was performed according to the manufacturers' specifications. Sensitivity, specificity, accuracy, and positive and negative predictive values for each assay were calculated using a consensus result of the 5 methods tested.Results:The sensitivity, specificity, and accuracy, respectively, of the test systems were as follows: IMx, 96%, 97%, and 96%; Rubazyme, 100%, 99%, and 99%; Rubascan, 100%, 98%, and 99%; Rubalex, 99%, 97%, and 98%; and FIAX 90%, 100%, and 95%. False negative reactions were seen with the FIAX system.Conclusions:The IMx system, a new “walk away” system from Abbott Diagnostic Laboratories and the Rubazyme systems performed well; however the latex agglutination tests proved to be the most rapid and convenient methods for screening sera for the presence of rubella immunity.

Elevated Faecal Calprotectin Levels are a Reliable Non-Invasive Screening Tool for Small Bowel Crohn’s Disease in Patients Undergoing Capsule Endoscopy

2018 ◽  
Vol 36 (3) ◽  
pp. 202-208 ◽  
Author(s):  
Hamid Yousuf ◽  
Umair Aleem ◽  
Roisin Egan ◽  
Pardeep Maheshwari ◽  
Jafaar Mohamad ◽  
...  
Keyword(s):  
At Risk ◽  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Characteristic Analysis ◽  
Faecal Calprotectin ◽  
Predictive Values ◽  
Patients At Risk ◽  
Sensitivity Specificity

Background: Approximately 10% of Crohn’s disease (CD) patients have this disease affecting the small bowel (SB) beyond the reach of Ileo-colonoscopy. Capsule endoscopy (SBCE) is the recommended investigation for SB disease. An accurate and inexpensive biomarker would help identify at-risk patients. Aim: To examine the efficacy of faecal calprotectin (FC) and C-reactive protein (CRP) as predictors of SBCE findings in suspected and known CD. Methods: A prospective observational study. Consecutive patients referred for SBCE gave FC and CRP samples. The diagnostic accuracy for SB CD based on SBCE result was calculated for both FC and CRP. Results: Of 100 invitees, FC and SBCE results were available in 64 cases. Correlation between FC >50 µg/g and SBCE result was poor К = 0.163; sensitivity, specificity, positive predictive value (PPV) and negative predictive values for ileitis were 60, 61, 32 and 83% respectively. PPV and specificity improved at FC >100 µg/g, 76 and 40%, correlation remained fair, К = 0.259. Receiver operating characteristic analysis had a sensitivity of 47% and specificity of 90% for FC >194 µg/g. CRP alone or in combination was an inaccurate predictor of ileitis. Conclusion: Our study suggests that FC level >194 µg/g may be a useful SBCE filter test, identifying patients at risk of SB CD.

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