scholarly journals A Systematic Review of Short Screening Instruments for Suicidal Behaviour in Primary Care

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Lukaschek K ◽  
◽  
Frank M ◽  
Gensichen J ◽  
Halfter K ◽  
...  
Keyword(s):  
Primary Care ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Time Management ◽  
Suicidal Behaviour ◽  
Risk Of Bias ◽  
Initial Assessment ◽  
Cochrane Library ◽  
Screening Instruments ◽  
Brief Screening

Background: Due to strict time management General Practitioners (GPs) prefer short instruments when identifying suicidal behaviour in their patients. We summarize the available studies reporting diagnostic accuracy of brief instruments for suicidal behaviour in primary care. Method: Databases MEDLINE, EMBASE, PsychINFO, PSYNDEX, and Cochrane Library were searched without any time constraints. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. The certainty of evidence was rated via GRADEpro. We included studies on primary care patients or participants from the general population. Suicidal behaviour was the defined target condition. With respect to the applicability in a primary care setting we included only studies assessing brief screening instruments; a brief instrument was defined as having no more than twelve items. We assessed sensitivity, specificity, and positive and negative predictive value. Results: A total of 9,969 studies was identified; of those, six fulfilled all strong criteria and were included. The range of sensitivity was 0.26-1.00, specificity was 0.64-0.99, positive predictive value 0.06-0.91, negative predictive value 0.86-1.00. Risk of bias was rated moderate and concerns regarding applicability acceptable. A required sensitivity of at least 0.80 and specificity of 0.50 with a moderate to high GRADE rating was achieved by six of nine index tests. Conclusions: Brief screening instruments can support ruling-out suicidality, but are less suitable for ruling-in. They may support GPs in an initial assessment, but in case of a positive test result, a valid diagnostic assessment should be done by a structured clinical interview.

scholarly journals A systematic review of brief screeners for suicidal behaviour in primary care

2019 ◽  
Author(s):  
Karoline Lukaschek ◽  
Milena Frank ◽  
Kathrin Halfter ◽  
Antonius Schneider ◽  
Jochen Gensichen
Keyword(s):  
Primary Care ◽  
General Population ◽  
Diagnostic Accuracy ◽  
Suicidal Behaviour ◽  
Risk Of Bias ◽  
Reference Standards ◽  
Cochrane Library ◽  
Test Accuracy ◽  
Index Test ◽  
Screening Instruments

Abstract Background As primary contacts, general practitioners can play a pivotal role in identifying suicidal behaviour in their patients. Therefore, actively screening patients at risk should be an integral part of primary care services. We summarized the available studies reporting diagnostic accuracy of short screening instruments for suicidal behaviour in primary care or the general population in a narrative synthesis. A brief instrument could improve the identification of vulnerable patients and their subsequent referral to mental health specialist. Methods: The following databases MEDLINE, EMBASE, PsychINFO, PSYNDEX, and Cochrane Library were searched in January 2019 without any time constraints. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. The certainty of evidence was rated via GRADEpro. The authors followed the PRISMA extensions for Diagnostic Test Accuracy Studies. Results Six relevant studies fulfilled all criteria and were included. Each index test was only assessed in a single study. The studies each used different reference standards. Target conditions defined across the different studies were suicidal ideation, suicide plan, suicide attempt, and suicidal behaviour in general. The diagnostic accuracy measurements sensitivity and specificity had a wide range (sensitivity: 26% - 100%, specificity: 64% - 99%). Risk of bias was rated moderate and concerns regarding applicability acceptable. A required sensitivity of at least 80% and specificity of 50% with a moderate to high GRADE rating was achieved by six of nine index tests. Conclusions Overall, only a few studies assessed screening instruments for suicidal behaviour in primary care or the general population. The identified studies were heterogeneous regarding sample size, index test, and reference standard. Since each index test was only evaluated in one study, their interpretability is limited. No uniform gold standard was found, as the studies identified used different reference standards. Although there are other promising short questionnaires, the majority has not yet been evaluated in primary care setting or the general population with regard to their diagnostic accuracy. A final assessment should always be based on the clinical judgement of the attending physician. Registration The study protocol was registered at PROSPERO (ID: CRD42019122173).

scholarly journals A systematic review of brief screeners for suicidal behaviour in primary care

2019 ◽  
Author(s):  
Karoline Lukaschek ◽  
Milena Frank ◽  
Kathrin Halfter ◽  
Antonius Schneider ◽  
Jochen Gensichen
Keyword(s):  
Primary Care ◽  
Suicidal Ideation ◽  
Diagnostic Accuracy ◽  
Diagnostic Test ◽  
Suicidal Behaviour ◽  
Risk Of Bias ◽  
Diagnostic Test Accuracy ◽  
Cochrane Library ◽  
Test Accuracy ◽  
Index Tests

Abstract Background: As primary contacts, general practitioners can play a pivotal role in identifying suicidal behaviour in their patients. A brief instrument could help in identifying vulnerable patients. We summarized the available studies reporting diagnostic accuracy of short screening instruments for suicidal behaviour in primary care or the general population in a narrative synthesis. Methods: The databases MEDLINE, EMBASE, PsychINFO, PSYNDEX, and Cochrane Library were searched in January 2019 without any time constraints. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. The certainty of evidence was rated via GRADEpro. The authors followed the PRISMA extensions for Diagnostic Test Accuracy Studies. Results: We identified a total of 9 969 studies with our search strategy. After the selection process, six relevant studies fulfilled all criteria and were included. They used the following index tests: Kessler Psychological Distress Scale, Suicidal Ideation Screening Questionnaire, Suicidal Ideation Attributes Scale, Gate question suicide attempt, Gate question suicidal ideation, Feeling suicidal, Wishing you were dead, Thoughts of death and Patient-Health-Questionaire-9 - item 9. The diagnostic accuracy measurements sensitivity and specificity had a wide range (sensitivity: 26% - 100%, specificity: 64% - 99%). Risk of bias was rated moderate and concerns regarding applicability acceptable. A required sensitivity of at least 80% and specificity of 50% with a moderate to high GRADE rating was achieved by six of nine index tests. Conclusions: The identified studies were heterogeneous regarding sample size, index test and reference standard. Even though screening of suicidal behaviour in primary care is already recommended by several guidelines, there are only few screeners in primary care that have been examined regarding their diagnostic accuracy. Although they can assist GPs in their judgement of suicidal behaviour of patients at risk, the final assessment is always based on the clinical judgement of the attending physician. Further diagnostic test accuracy studies of promising short questionnaires are needed. Registration: The study protocol was registered at PROSPERO (ID: CRD42019122173).

scholarly journals Evidence base for point-of-care ultrasound (POCUS) for diagnosis of skull fractures in children: a systematic review and meta-analysis

2020 ◽  
pp. emermed-2020-209887
Author(s):  
Georgios Alexandridis ◽  
Eva W Verschuuren ◽  
Arthur V Rosendaal ◽  
Danny A Kanhai
Keyword(s):  
Head Injury ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Point Of Care ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Point Of Care Ultrasound ◽  
Skull Fractures ◽  
Fractures In Children

BackgroundBlunt head trauma is a common presentation to emergency departments (EDs). Identifying skull fractures in children is important as they are known factor of risk for traumatic brain injury (TBI). Currently, CT is the reference standard for diagnosing skull fractures and TBIs in children. Identifying skull fractures with point-of-care ultrasound (POCUS) may help risk-stratify children for TBI following blunt trauma. The purpose of this study is to evaluate the sensitivity, specificity, positive predictive value and negative predictive value of POCUS in identifying skull fractures in children.MethodsA systematic search was performed on 17 July 2020 in Ovid Medline, Cochrane Library, Google Scholar, Web of Science and Embase. Prospective studies reporting skull fractures diagnosed with ultrasound in children younger than 18 years due to blunt head injury were included. Studies that did not confirm the fracture with CT were excluded. The quality of studies was evaluated using the QUADAS-2 tool. Data were extracted from the eligible studies to calculate outcomes such as sensitivity and specificity; when possible overall outcomes were calculated.ResultsSeven studies were included. All eligible studies included patients for whom the decision to perform a CT scan was made in advance. Overall, the included studies demonstrated low risk of bias or had minor concerns regarding risk of bias. The pooled data (n=925) demonstrated a sensitivity of 91%, specificity of 96%, positive predictive value of 88% and negative predictive value of 97%.ConclusionThe included studies demonstrate minor methodological limitations. Overall, the evidence suggests that POCUS is a valid option for diagnosing skull fractures in children visiting the ED after blunt head injury.

scholarly journals The utility of prostate MRI within active surveillance: description of the evidence

2021 ◽  
Author(s):  
Georgina Dominique ◽  
Wayne G. Brisbane ◽  
Robert E. Reiter
Keyword(s):  
Prostate Cancer ◽  
Negative Predictive Value ◽  
Active Surveillance ◽  
Predictive Value ◽  
Multiparametric Mri ◽  
Cochrane Library ◽  
Resonance Imaging ◽  
Active Monitoring ◽  
Initial Biopsy ◽  
Clinically Significant

Abstract Purpose We present an overview of the literature regarding the use of MRI in active surveillance of prostate cancer. Methods Both MEDLINE® and Cochrane Library were queried up to May 2020 for studies of men on active surveillance with MRI and later confirmatory biopsy. The terms studied were ‘prostate cancer’ as the anchor followed by two of the following: active surveillance, surveillance, active monitoring, MRI, NMR, magnetic resonance imaging,  MRI, and multiparametric MRI. Studies were excluded if pathologic reclassification (GG1 →  ≥ GG2) and PI-RADS or equivalent was not reported. Results Within active surveillance, baseline MRI is effective for identifying clinically significant prostate cancer and thus associated with fewer reclassification events. A positive initial MRI (≥ PI-RADS 3) with GG1 identified at biopsy has a positive predictive value (PPV) of 35–40% for reclassification by 3 years. MRI possessed a stronger negative predictive value, with a negative MRI (≤ PI-RADS 2) yielding a negative predictive value of up to 85% at 3 years. Surveillance MRI, obtained after initial biopsy, yielded a PPV of 11–65% and NPV of 85–95% for reclassification. Conclusion MRI is useful for initial risk stratification of prostate cancer in men on active surveillance, especially if MRI is negative when imaging is obtained during surveillance. While useful, MRI cannot replace biopsy and further research is necessary to fully integrate MRI into active surveillance.

Identifying Dementia in the Primary Care Practice

2000 ◽  
Vol 12 (4) ◽  
pp. 483-493 ◽  
Author(s):  
Paul R. Solomon ◽  
Michael Brush ◽  
Vivian Calvo ◽  
Felicity Adams ◽  
Richard D. DeVeaux ◽  
...  
Keyword(s):  
Primary Care ◽  
Negative Predictive Value ◽  
Random Sample ◽  
Predictive Value ◽  
Primary Care Practice ◽  
Diagnostic Evaluation ◽  
Care Practice ◽  
Test Retest Reliability ◽  
Cognitive Problems

Background: The purpose of this study was to evaluate the utility (i.e., positive and negative predictive value) of the 7 Minute Screen in identifying patients with probable Alzheimer's disease (AD) in a primary care practice. A second objective was to estimate the number of undiagnosed AD patients in a typical primary care practice. Methods: One hundred thirty-seven successive admissions (96%) of patients over the age of 60 to a primary care practice over a 53-day period who completed informed consent documents were administered the 7 Minute Screen. All patients who screened positive (n = 13) and a random sample of those who screened negative (n = 26) returned for full diagnostic evaluation. Positive predictive value (PPV) and negative predictive value (NPV) of the 7 Minute Screen were determined using the criterion standard of clinical diagnosis established by examination, history, and laboratory studies. Test-retest reliability and time for administration were also determined. Results: Of the 137 patients evaluated, 13 screened positive and 124 screened negative. Eleven of the 13 patients who screened positive were willing to return to the primary care practice for follow-up evaluation. A random sample of 26 patients who screened negative all agreed to return for follow-up evaluation. Of the 11 patients who screened positive who returned for evaluation, 10 were subsequently diagnosed with probable AD. The remaining patient was diagnosed with mixed dementia. The caregivers of the two patients who refused to return were contacted and both indicated that the patients were having significant cognitive problems as verified by an activities of daily living scale. Of the 26 patients who screened negative, 25 were judged to be cognitively normal and the 26th was judged to have mild cognitive impairment. Discussion: In successive admissions of patients over the age of 60 in a primary care practice, the 7 Minute Screen showed a PPV of 91% and an NPV of 96% in identifying patients who were subsequently identified with AD or other dementing disorder. These data suggest that this may be a useful instrument in identifying patients who should undergo diagnostic evaluation for AD and other dementing disorders. Additionally, extrapolation from the data in this practice suggests that there may be between 75 and 100 AD patients in the typical primary care practice, many of whom may not be diagnosed.

scholarly journals Sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms: a systematic review

2019 ◽  
Vol 69 (689) ◽  
pp. e827-e835 ◽  
Author(s):  
Stephen H Bradley ◽  
Sarah Abraham ◽  
Matthew EJ Callister ◽  
Adam Grice ◽  
William T Hamilton ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Primary Care ◽  
High Risk ◽  
Grey Literature ◽  
Primary Objective ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
X Ray ◽  
Chest X Ray

BackgroundDespite increasing use of computed tomography (CT), chest X-ray remains the first-line investigation for suspected lung cancer in primary care in the UK. No systematic review evidence exists as to the sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms.AimTo estimate the sensitivity of chest X-ray for detecting lung cancer in symptomatic people.Design and settingA systematic review was conducted to determine the sensitivity of chest X-ray for the detection of lung cancer.MethodDatabases including MEDLINE, EMBASE, and the Cochrane Library were searched; a grey literature search was also performed.ResultsA total of 21 studies met the eligibility criteria. Almost all were of poor quality. Only one study had the diagnostic accuracy of chest X-ray as its primary objective. Most articles were case studies with a high risk of bias. Several were drawn from non-representative groups, for example, specific presentations, histological subtypes, or comorbidities. Only three studies had a low risk of bias. Two primary care studies reported sensitivities of 76.8% (95% confidence interval [CI] = 64.5 to 84.2%) and 79.3% (95% CI = 67.6 to 91.0%). One secondary care study reported a sensitivity of 79.7% (95% CI = 72.7 to 86.8%).ConclusionThough there is a paucity of evidence, the highest-quality studies suggest that the sensitivity of chest X-ray for symptomatic lung cancer is only 77% to 80%. GPs should consider if further investigation is necessary in high-risk patients who have had a negative chest X-ray.

scholarly journals Discriminating complicated from uncomplicated appendicitis by ultrasound imaging, computed tomography or magnetic resonance imaging: systematic review and meta-analysis of diagnostic accuracy

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
W J Bom ◽  
M D Bolmers ◽  
S L Gans ◽  
C C van Rossem ◽  
A A W van Geloven ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Ultrasound Imaging ◽  
Predictive Value ◽  
Complicated Appendicitis ◽  
Cochrane Library ◽  
Uncomplicated Appendicitis ◽  
Mean Sensitivity ◽  
Ct And Mri

Abstract Background Discriminating complicated from uncomplicated appendicitis is crucial. Patients with suspected complicated appendicitis are best treated by emergency surgery, whereas those with uncomplicated appendicitis may be treated with antibiotics alone. This study aimed to obtain summary estimates of the accuracy of ultrasound imaging, CT and MRI in discriminating complicated from uncomplicated appendicitis Methods A systematic literature review was conducted by an electronic search in PubMed, Embase and the Cochrane Library for studies describing the diagnostic accuracy of complicated versus uncomplicated appendicitis. Studies were included if the population comprised adults, and surgery or pathology was used as a reference standard. Risk of bias and applicability were assessed with QUADAS-2. Bivariable logitnormal random-effect models were used to estimate mean sensitivity and specificity. Results Two studies reporting on ultrasound imaging, 11 studies on CT, one on MRI, and one on ultrasonography with conditional CT were included. Summary estimates for sensitivity and specificity in detecting complicated appendicitis could be calculated only for CT, because of lack of data for the other imaging modalities. For CT, mean sensitivity was 78 (95 per cent c.i. 64 to 88) per cent, and mean specificity was 91 (85 to 99) per cent. At a median prevalence of 25 per cent, the positive predictive value of CT for complicated appendicitis would be 74 per cent and its negative predictive value 93 per cent. Conclusion Ultrasound imaging, CT and MRI have limitations in discriminating between complicated and uncomplicated appendicitis. Although CT has far from perfect sensitivity, its negative predictive value for complicated appendicitis is high.

scholarly journals Role of hysterosalpingography in evaluation of tubal factors and its comparison with sonosalpingography

2016 ◽  
Vol 6 (1) ◽  
pp. 121
Author(s):  
Rainee Agrawal ◽  
Deepti Shrivastava
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Invasive Procedure ◽  
Cross Sectional Study ◽  
Initial Assessment ◽  
Good Resolution ◽  
Cross Sectional ◽  
Tubal Patency

Background: Laparoscopy is considered as the gold standard for assessment of tubal factors of infertility, although because of its invasive nature, cost and the need for anaesthesia and hospitalization, HSG seems to be a basic routine procedure for tubal factors. Currently with the availability of the ultrasonography machines with very good resolution, SSG can be simultaneously practiced with ultrasonography during day 7-9 of the menstrual cycle to assess tubal patency. Hence, the present study was designed to compare the accuracy of HSG with SSG for evaluation of tubal factor infertility.Methods: This was a prospective cross-sectional study of 100 consecutive women with primary or secondary infertility without active pelvic infection, selected from OPD of Department of Obstetrics and Gynaecology, Acharya Vinoba Bhave Rural Hospital associated with Datta Meghe Institute of Medical Sciences University, Sawangi (Meghe), Wardha over a period of two years from September 2014 to August 2016.Results: In the present study for diagnosing tubal patency SSG had sensitivity of 88.64%, specificity of 75%, positive predictive value of 96.29% and negative predictive value of 47.36% and diagnostic accuracy of 87%, while HSG had sensitivity of 94.32%, specificity of 83.33%, positive predictive value of 97.64% and negative predictive value of 66.66% and diagnostic accuracy of 93%.Conclusions: Initial assessment of tubal patency by HSG is better than SSG as an indirect, outdoor, non-invasive procedure although with minimal radiation hazards. It allows documentation of tubal patency enables detection of several tubal lesions and permits assessments of the fine intratubal architectural details as well as little uterine pathology. It will help in reducing the number of laparoscopic procedures and their related complications and health care costs for confirmation of tubal patency.

scholarly journals Risk Factors for the Prediction of Hyperglycemia during Pregnancy – A Cohort Study from a Brazilian Public Primary Care Center

2020 ◽  
Author(s):  
Joice Monaliza Vernini ◽  
Bianca Nicolosi Cassetari ◽  
Mariana Alvarez Arantes ◽  
Roberto Araújo Costa ◽  
Claudia Garcia Magalhães ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Body Mass Index ◽  
Cohort Study ◽  
Negative Predictive Value ◽  
Body Mass ◽  
Gestational Age ◽  
Predictive Value ◽  
Fasting Glucose ◽  
Primary Care Center

Abstract BACKGROUND – In Brazil, the prevalence of maternal hyperglycemia is among the highest, costs are elevated and there is no evidence to recommend universal screening. OBJECTIVE – To evaluate the performance of risk factors (RF) for predicting hyperglycemia in pregnancy – Mild Gestational Hyperglycemia (MGH) or gestational Diabetes Mellitus (GDM) in public primary-care centers in Brazil. METHODS – A cohort study, including 514 women with a single pregnancy and no hyperglycemia. Study participants were evaluated at GA (gestational age) < or ≥ 20 weeks, and underwent a 75g-OGTT along with glycemic profile (GP) testing between 24 and 28 weeks. Clinical, anthropometric and laboratory data – fasting glucose (FG), glycated hemoglobin (HbA1c), basal insulin and lipid profile were obtained. The most common RF associations (OR and 95% CI and p <0.05) and different cut-off points were tested for the prediction of MGH-GDM. Predictive performance was assessed by Sensitivity/Specificity, negative predictive value NPV (negative predictive value) and false positive rates (FP; 1-Esp). RESULTS – At GA <20 weeks, age ≥25 years, WC (Waist circumference) ≥ 88 cm, BMI pre ≥25 kg/m 2 (pre gestational body mass index) and BMI gest ≥25 kg/m 2 (gestational body mass index ); at GA (gestational age) ≥20 weeks, age ≥25 years, BMI pre ≥25 kg/m 2 and TG (triglicerides) ≥150 mg/dL showed better performace for predicting MGH-GDM. Irrespective of gestational age, FG (Fasting glucose) ≥ 85 mg/dL, HbA1c ≥5.7% and HOMA-IR ≥2.71 were good predictors to rule out the risk of these complications. CONCLUSION – The results of this study should contribute to define the best diagnostic approach to MGH-GDM in our center and in others with similar characteristics.

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