scholarly journals A Mobile App to Screen for Neurocognitive Impairment: Preliminary Validation of NeuroScreen Among HIV-Infected South African Adults (Preprint)

2017 ◽  
Author(s):  
Reuben N Robbins ◽  
Hetta Gouse ◽  
Henry G Brown ◽  
Andries Ehlers ◽  
Travis M Scott ◽  
...  
Keyword(s):  
South African ◽  
Sensitivity And Specificity ◽  
Gold Standard ◽  
Health Workers ◽  
Neuropsychological Test ◽  
Test Battery ◽  
Clinical Staff ◽  
Composite Score ◽  
Lay Health Workers ◽  
Standard Neuropsychological Test

BACKGROUND Neurocognitive impairment (NCI) is one of the most common complications of HIV infection, and has serious medical and functional consequences. South Africa has 7 million people living with HIV (PLHIV) with up to three-quarters of antiretroviral therapy (ART)-naïve individuals having NCI. South Africa’s health system struggles to meet the care needs of its millions of PLHIV; screening for NCI is typically neglected due to limited clinical staff trained to administer, score, and interpret neuropsychological tests, as well as long test batteries and limited screening tools for South African populations. Without accurate, clinically useful, and relatively brief NCI screening tests that can be administered by all levels of clinical staff, critical opportunities to provide psychoeducation, behavioral planning, additional ART adherence support, and adjuvant therapies for NCI (when they become available) are missed. To address these challenges and gap in care, we developed an mHealth app screening tool, NeuroScreen, to detect NCI that can be administered by all levels of clinical staff, including lay health workers. OBJECTIVE The purpose of this study was to examine sensitivity and specificity of an adapted version of NeuroScreen to detect NCI (as determined by a gold standard neuropsychological test battery administered by a trained research psychometrist) among HIV-infected South Africans when administered by a lay health worker. METHODS A total of 102 HIV-infected black South African adults who had initiated ART at least 12 months prior were administered NeuroScreen and a gold standard neuropsychological test battery in the participants’ choice of language (ie, English or isiXhosa). Three composite z scores were calculated for NeuroScreen: (1) sum of all individual test scores, (2) sum of all individual test scores and error scores from four tests, and (3) sum of four tests (abbreviated version). Global deficit scores were calculated for the gold standard battery where a score of 0.5 or greater indicated the presence of NCI. RESULTS The mean age of participants was 33.31 (SD 7.46) years, most (59.8%, 61/102) had at least 12 years of education, and 81.4% (83/102) of the sample was female. Gold standard test battery results indicated that 26.5% (27/102) of the sample had NCI. Sensitivity and specificity of age-, education-, and sex-adjusted NeuroScreen scores were 81.48% and 74.67% for composite score 1, 81.48% and 81.33% for composite score 2, and 92.59% and 70.67% for composite score 3, respectively. CONCLUSIONS NeuroScreen, a highly automated, easy-to-use, tablet-based screening test to detect NCI among English- and isiXhosa-speaking South African HIV patients demonstrated robust sensitivity and specificity to detect NCI when administered by lay health workers. NeuroScreen could help make screening for NCI more feasible. However, additional research is needed with larger samples and normative test performance data are needed.

Halstead-Reitan Test Battery: A Problem of Differential Diagnosis

1980 ◽  
Vol 50 (2) ◽  
pp. 611-630
Author(s):  
Irmingard I. Lenzer
Keyword(s):  
Brain Damage ◽  
Test Performance ◽  
Construct Validation ◽  
Neuropsychological Test ◽  
Summary Score ◽  
Test Battery ◽  
Medical Patients ◽  
Test Taking ◽  
Limited Applicability ◽  
Schizophrenic Patients

The Halstead-Reitan Test Battery is one of the most widely recognized neuropsychological test batteries. Many claims have been made as to its validity. Despite these claims, doubts persist. A critical review of the literature shows that the battery can separate brain-damaged patients from normal patients, general medical patients, and patients with certain psychiatric disorders. However, the battery cannot separate brain-damaged patients as a group from schizophrenics as a group, though in individual cases there may exist pathognomonic signs indicating brain damage. The impairment index, as a summary score of the basic tests, as well as other “methods of inference,” fail at this point. Four alternatives are discussed. First, brain-damaged patients differ from schizophrenic patients not in test performance but in test-taking behavior. Second, the battery is a valid measure of brain damage but has limited applicability. Third, the battery is a measure not of brain damage but of degree of degradation of psychological processes. And fourth, schizophrenics perform poorly on the battery because they have undetected brain damage. Only the third and fourth alternatives appear viable. Both question the validity of the traditional criteria of brain damage. It is argued that future validation studies of the battery should be of construct validation type and not of the criterion-oriented type, as these are defined by Cronbach and Meehl (1955). Possible procedures for construct validation are briefly discussed.

scholarly journals Multicentre methodological study to create a publicly available score of hospital financial standing in the USA

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046500
Author(s):  
Radoslav Zinoviev ◽  
Harlan M Krumholz ◽  
Richard Ciccarone ◽  
Rick Antle ◽  
Howard P Forman
Keyword(s):  
Gold Standard ◽  
Financial Stability ◽  
Credit Rating ◽  
Financial Data ◽  
Composite Score ◽  
Methodological Study ◽  
Bond Ratings ◽  
Hospital Operations ◽  
Initial Dataset ◽  
The Usa

ObjectivesTo create a straightforward scoring procedure based on widely available, inexpensive financial data that provides an assessment of the financial health of a hospital.DesignMethodological study.SettingMulticentre study.ParticipantsAll hospitals and health systems reporting the required financial metrics in the USA in 2017 were included for a total of 1075 participants.InterventionsWe examined a list of 232 hospital financial indicators and used existing models and financial literature to select 30 metrics that sufficiently describe hospital operations. In a set of hospital financial data from 2017, we used principal coordinate analysis to assess collinearity among variables and eliminated redundant variables. We isolated 10 unique variables, each assigned a weight equal to the share of its coefficient in a regression onto Moody’s Credit Rating, our predefined gold standard. The sum of weighted variables is a single composite score named the Yale Hospital Financial Score (YHFS).Primary outcome measuresAbility to reproduce both financial trends from a ‘gold-standard’ metric and known associations with non-fiscal data.ResultsThe validity of the YHFS was evaluated by: (1) cross-validating it with previously excluded data; (2) comparing it to existing models and (3) replicating known associations with non-fiscal data. Ten per cent of the initial dataset had been reserved for validation and was not used in creating the model; the YHFS predicts 96.7% of the variation in this reserved sample, demonstrating reproducibility. The YHFS predicts 90.5% and 88.8% of the variation in Moody’s and Standard and Poor’s bond ratings, respectively, supporting its validity. As expected, larger hospitals had higher YHFS scores whereas a greater share of Medicare discharges correlated with lower YHFS scores.ConclusionsWe created a reliable and publicly available composite score of hospital financial stability.

Facial emotion recognition and its relationship to cognition and depressive symptoms in patients with Parkinson's disease

2016 ◽  
Vol 28 (7) ◽  
pp. 1165-1179 ◽  
Author(s):  
J. Pietschnig ◽  
L. Schröder ◽  
I. Ratheiser ◽  
I. Kryspin-Exner ◽  
M. Pflüger ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Emotion Recognition ◽  
Recognition Performance ◽  
Neuropsychological Test ◽  
Test Battery ◽  
Facial Emotion Recognition ◽  
Facial Emotion ◽  
Healthy Controls ◽  
Amnestic Mci ◽  
Cognitively Intact

ABSTRACTBackground:Impairments in facial emotion recognition (FER) have been detected in patients with Parkinson disease (PD). Presently, we aim at assessing differences in emotion recognition performance in PD patient groups with and without mild forms of cognitive impairment (MCI) compared to healthy controls.Methods:Performance on a concise emotion recognition test battery (VERT-K) of three groups of 97 PD patients was compared with an age-equivalent sample of 168 healthy controls. Patients were categorized into groups according to two well-established classifications of MCI according to Petersen's (cognitively intact vs. amnestic MCI, aMCI, vs. non-amnestic MCI, non-aMCI) and Litvan's (cognitively intact vs. single-domain MCI, sMCI, vs. multi-domain MCI, mMCI) criteria. Patients and controls underwent individual assessments using a comprehensive neuropsychological test battery examining attention, executive functioning, language, and memory (Neuropsychological Test Battery Vienna, NTBV), the Beck Depression Inventory, and a measure of premorbid IQ (WST).Results:Cognitively intact PD patients and patients with MCI in PD (PD-MCI) showed significantly worse emotion recognition performance when compared to healthy controls. Between-groups effect sizes were substantial, showing non-trivial effects in all comparisons (Cohen's ds from 0.31 to 1.22). Moreover, emotion recognition performance was higher in women, positively associated with premorbid IQ and negatively associated with age. Depressive symptoms were not related to FER.Conclusions:The present investigation yields further evidence for impaired FER in PD. Interestingly, our data suggest FER deficits even in cognitively intact PD patients indicating FER dysfunction prior to the development of overt cognitive dysfunction. Age showed a negative association whereas IQ showed a positive association with FER.

scholarly journals Mobile health messaging service and helpdesk for South African mothers (MomConnect): history, successes and challenges

2018 ◽  
Vol 3 (Suppl 2) ◽  
pp. e000559 ◽  
Author(s):  
Peter Barron ◽  
Joanne Peter ◽  
Amnesty E LeFevre ◽  
Jane Sebidi ◽  
Marcha Bekker ◽  
...  
Keyword(s):  
Pregnant Women ◽  
South African ◽  
Mobile Health ◽  
Health Workers ◽  
Digital Health ◽  
Universal Coverage ◽  
Text Messages ◽  
Time Data ◽  
Department Of Health ◽  
Early Decision

MomConnect is a flagship programme of the South African National Department of Health that has reached over 1.5 million pregnant women. Using mobile technology, MomConnect provides pregnant and postpartum women with twice-weekly health information text messages as well as access to a helpdesk for patient queries and feedback. In just 3 years, MomConnect has been taken to scale to reach over 95% of public health facilities and has reached 63% of all pregnant women attending their first antenatal appointment. The helpdesk has received over 300 000 queries at an average of 250 per day from 6% of MomConnect users. The service is entirely free to its users. The rapid deployment of MomConnect has been facilitated by strong government leadership, and an ecosystem of mobile health implementers who had experience of much of the content and technology required. An early decision to design MomConnect for universal coverage has required the use of text-based technologies (short messaging service and Unstructured Supplementary Service Data) that are accessible via even the most basic mobile phones, but cumbersome to use and costly at scale. Unlike previous mobile messaging services in South Africa, MomConnect collects the user’s identification number and facility code during registration, enabling future linkages with other health and population databases and geolocated feedback. MomConnect has catalysed additional efforts to strengthen South Africa’s digital health architecture. The rapid growth in smartphone penetration presents new opportunities to reduce costs, increase real-time data collection and expand the reach and scope of MomConnect to serve health workers and other patient groups.

Association between endometritis and urocystitis in culled sows

2002 ◽  
Vol 50 (4) ◽  
pp. 413-423 ◽  
Author(s):  
I. Biksi ◽  
N. Takács ◽  
F. Vetési ◽  
Keyword(s):  
Sensitivity And Specificity ◽  
Gold Standard ◽  
Positive Association ◽  
Urogenital Tract

Slaughterhouse sampling and examination of urogenital tracts of 499 sows and gilts culled for reproductive reasons from 21 Hungarian herds were performed over a 6-year period. The aim was to estimate the prevalence of different urogenital tract lesions, and to provide sensitivity and specificity estimates for macroscopic and bacteriological examinations in the diagnosis of urocystitis and endometritis. Furthermore, the association between endometritis and urocystitis was assessed. The prevalence of main lesions of the urogenital tract was similar to that reported in other studies. The 'sensitivity' of macroscopic and bacteriological methods was determined statistically by taking histopathology as the 'Gold Standard'. As a result, the 'sensitivity' of macroscopic methods for the diagnosis of endometritis and urocystitis was ≤ 18.1% and 47.9%, respectively, while the 'sensitivity' of bacteriology for the diagnosis of the same conditions was ≤ 31.8% and 63.0%, respectively. The presumed positive association between urocystitis and endometritis was confirmed; it was not confounded by parity. Animals affected by urocystitis had a 3.5 times higher odds to simultaneously have endometritis than animals without urocystitis.

scholarly journals The role of magnetic resonance cholangiopancreatography and diffusion-weighted imaging for the differential diagnosis of obstructive biliary disorders

2017 ◽  
Vol 21 (1) ◽  
Author(s):  
Zeynep Cetiner-Alpay ◽  
Fatma Kulali ◽  
Aslihan Semiz-Oysu ◽  
Yasar Bukte ◽  
Kamil Ozdil
Keyword(s):  
Magnetic Resonance ◽  
Sensitivity And Specificity ◽  
Gold Standard ◽  
Diffusion Weighted Imaging ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Malignant Tumours ◽  
Diagnostic Efficacy ◽  
Diffusion Weighted ◽  
Sensitivity Specificity ◽  
And Diffusion

Background: Although endoscopic retrograde cholangiopancreatography (ERCP) is accepted as the gold standard, there is a place for magnetic resonance cholangiopancreatography (MRCP) and diffusion-weighted imaging (DWI) in the diagnosis of obstructive biliary disorders.Aim: To compare the findings of MRCP with ERCP in patients with obstructive biliary disorders and to investigate the diagnostic efficacy of MRCP combined with DWI.Study design: Retrospective, analytic, cross-sectional study.Methods: The MRCP images of 126 patients who underwent both MRCP and ERCP owing to biliary obstruction were reviewed. Nine patients were excluded because of incomplete diagnostic workup or a long period (>3 months) between MRCP and ERCP. Ninety-two patients underwent DWI, which was also evaluated. The sensitivity, specificity and accuracy of MRCP and DWI were analysed.Results: The sensitivity, specificity and accuracy of MRCP according to ERCP results as the gold standard was 97%, 71% and 93% for assessment of biliary dilatation; 100%, 94.7% and 97.5% for the diagnosis of choledocholithiasis; 93.7%, 100% and 99% for the identification of benign strictures; 100%, 100% and 100% for the diagnosis of malignant tumours; and 100%, 100% and 100% for the detection of complicated hydatid cysts; respectively. The sensitivity and specificity of DWI for the diagnosis of malignant tumour was 100%. In the detection of choledocholithiasis, the sensitivity and specificity of DWI was 70.8% and 100%.Conclusions: MRCP is an alternative, non-invasive, diagnostic modality, comparable with ERCP for the evaluation of pancreaticobiliary diseases. DWI can be helpful for diagnosis of choledocholithiasis and tumours.

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