La formazione dei medici alla diagnosi di abuso come importante contributo al miglioramento della rilevazione

2009 ◽  
pp. 61-75
Author(s):  
Dante Baronciani ◽  
Luciana Nicoli ◽  
Massimo Masi ◽  
Isa Ruffilli
Keyword(s):  
Child Abuse ◽  
Diagnostic Accuracy ◽  
Key Words ◽  
False Positive ◽  
False Negative ◽  
Diagnostic Algorithm ◽  
Imaging Diagnosis ◽  
Limited Knowledge ◽  
Specific Project ◽  
The Web

- The limited contribution of doctors to the notification of suspected abuse cases stems, for the most part, out of the limited knowledge of physical signs of abuse. In this paper the authors illustrate a specific project of education of doctors about physical signs of abuse, based on the use of an information tool available both on paper and on the web. An example is discussed in the paper, about fractures: details are given about a diagnostic algorithm, which requests the presence (or the consultation with) specifically trained doctors, intended to increase diagnostic accuracy (reducing both false positive and false negative cases).Key words: child abuse, fractures, Rx imaging, diagnosis.Parole chiave: abuso, fratture, immagini radiologiche, diagnosi.

Simple modifications of three routine in vitro tests of thyroid function.

1976 ◽  
Vol 22 (10) ◽  
pp. 1715-1718 ◽  
Author(s):  
R W Pain
Keyword(s):  
Diagnostic Accuracy ◽  
Thyroid Function ◽  
False Positive ◽  
Reference Range ◽  
False Negative ◽  
Work Load ◽  
In Vitro Tests ◽  
Free Thyroxine Index ◽  
Total Thyroxine

Abstract Semi-automation of equipment and simple modifications of technique reduced the work load without loss of diagnostic accuracy for three commonly used in vitro tests of thyroid function (total thyroxine, thyrobinding index, and free thyroxine index). Major innovations were the use of serum standards for all tests and having each duplicate for tests performed by a different technician. Attention is drawn to the false-positive and false-negative errors that occur when the 95% euthyroid limits is the sole reference range used.

scholarly journals High Diagnostic Accuracy of Antigen Microarray for Sensitive Detection of Hepatitis C Virus Infection

2008 ◽  
Vol 54 (2) ◽  
pp. 424-428 ◽  
Author(s):  
Jung-ah Kwon ◽  
Hyeseon Lee ◽  
Kap N o Lee ◽  
Kwangchun Chae ◽  
Seram Lee ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Detection Limit ◽  
Diagnostic Accuracy ◽  
False Positive ◽  
Sol Gel ◽  
False Negative ◽  
Screening Method ◽  
Confirmatory Test ◽  
Specificity And Sensitivity

Abstract Background: Hepatitis C virus (HCV) can be transmitted through blood transfusion. Screening ELISA, the most widely used method for HCV diagnosis, sometimes yields false-positive and false-negative results, so a confirmatory test is used. This secondary testing is labor-intensive and expensive, and thus is impractical for massive blood bank screening. Therefore, a new massive screening method with high accuracy is needed for sensitive and specific detection of HCV. Methods: With sol-gel material, we designed novel antigen microarray in 96-well plates for HCV detection. Each individual well was spotted with 4 different HCV antigens. We used this new system to test 154 patient serum samples previously tested for HCV by ELISA (87 HCV positive and 67 HCV negative) (HCV EIA3.0, ABBOTT). We assessed the detection limit of our microarray system with the use of serial 10-fold dilutions of an HCV-positive sample. Results: Our microarray assay was reproducible and displayed higher diagnostic accuracy (specificity) (98.78%) than did the ELISA (81.71%). Our method yielded significantly fewer false-positive results than did the ELISA. The detection limit of our assay was 1000 times more sensitive than that of the ELISA. In addition, we found this novel assay technology to be compatible with the currently employed automated methods used for ELISA. Conclusion: We successfully applied the sol-gel–based protein microarray technology to a screening assay for HCV diagnosis with confirmatory test-level accuracy. This new, inexpensive method will improve the specificity and sensitivity of massive sample diagnosis.

scholarly journals Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yanli Zhu ◽  
Yuntao Song ◽  
Guohui Xu ◽  
Zhihui Fan ◽  
Wenhao Ren
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
False Positive ◽  
False Negative ◽  
Diagnostic Errors ◽  
Published Data ◽  
Cystic Lesions ◽  
Adenomatous Hyperplasia ◽  
Sensitivity Specificity

Abstract Objective FNA is a simple, safe, cost-effective and accurate diagnostic tool for the initial screening of patients with thyroid nodules. The aims of this study were to determine the diagnostic utility of FNAC performed in our institution, assess the cytomorphologic features that contribute to diagnostic errors and propose improvement measures. Methods A total of 2781 FNACs were included in the study, and 1122 cases were compared with their histological diagnoses. We retrospectively reexamined our discordant (both false-negative and false-positive) cases and performed a systematic review of previous studies on causes of misdiagnoses. Results When DC V and DC VI were both considered cytologic-positive, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 98.3, 30.9, 94.9, 58.3 and 93.5%, respectively. If DC VI was considered cytologic-positive, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC were 98.0, 84.0, 99.4, 58.3, and 97.5% respectively. The main cause of false-negative diagnoses was sampling error (13/15, 86.7%), while interpretation error led to the majority of the false-positive diagnoses (38/47, 80.9%). Overlapping cytological features in adenomatous hyperplasia, thyroiditis and cystic lesions were the major factors contributing to interpretation errors, while the size and number of nodules may have led to false-negative diagnoses because of heterogeneity and unsampled areas. Conclusions The sensitivity and PPV of thyroid FNAC in our institution were higher than those in the published data, while the specificity and NPV were lower. Regarding the FNA category DC V, a frozen section analysis during diagnostic lobectomy is necessary. Multiple passes should be performed in various parts of a large nodule or from different nodules to reduce the risk of false-negative findings. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis and cystic lesions to avoid false-positive diagnoses. NIFTP has little effect on diagnostic accuracy and the distribution of diagnostic errors.

811 WHETHER 10 WATER SWALLOWS NECESSARY TO OBTAIN REPRODUCIBLE RESULTS OF HIGH-RESOLUTION OESOPHAGEAL MANOMETRY?

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Sergey Morozov ◽  
Vasily Kropochev ◽  
Alexey Artemov
Keyword(s):  
High Resolution ◽  
Diagnostic Accuracy ◽  
False Positive ◽  
Roc Analysis ◽  
Characteristic Curve ◽  
False Negative ◽  
Ratio Test ◽  
Type I ◽  
Primary Position ◽  
Oesophageal Manometry

Abstract   Not less than ten wet swallows assessment in the primary test position is recommended by Chicago classification 4.0 for high-resolution oesophageal manometry (HREM); however, the required number of measurements are not sufficiently supported. Aim to evaluate the number of wet swallows necessary for correct interpretation of the results of lower esophageal sphincter integrated relaxation pressure (IRP) with low probability of type I and II errors. Methods Patients referred to perform HREM were enrolled. Solid-state 10Fr catheter and Solar (Laborie) software were used. Minimum 10 swallows by 5 mL water were obtained. These were analysed for cumulative means of IRP after 1…9 measurements. Conclusion made at each moment was compared with one based on 10 measurements. The results were characterized as true/false positive/negative for calculation of diagnostic accuracy. To exclude sample influence, Monte-Carlo simulation of sequential decision-making was performed with the use of sequential probability ratio test. Association of the diagnostic accuracy from recall was studied with the use of receiver operating characteristic curve (ROC) analysis. Results One hundred subjects were enrolled (25 with disorders of EGJ outflow). During the simulation, the probability of matching the decisions based on the 10 measurements and lower number of them was high. ROC analysis showed that actual probability to obtain false-positive results was twice as lower then ‘allowed’ rate of 5%. The probability to make false-negative results did not exceed 10% in any number of measurements. The probability that the conclusions made after 2 and after 10 measurements match was 0.9584 in those with disorders of EGJ outflow and 0.9652 in those without (figure 1). Conclusion The standard number of measurements required to support the presence of disorders of EGJ outflow during evaluation of 5 mL wet swallows in the primary position is excessive. Values of the IRP after 2 swallows allows to make similar decision to that after 10 swallows with >95% probability. This allows to reduce the number of wet swallows to assess in the primary position and save time for assessments in alternative position or perform provocation tests.

Methylene Blue as a Diagnosis and Screening Tool for Oral Cancer and Precancer

2020 ◽  
pp. 019459982094768
Author(s):  
Se Hwan Hwang ◽  
Sung Won Kim ◽  
Eun A. Song ◽  
Junuk Lee ◽  
Do Hyun Kim
Keyword(s):  
Methylene Blue ◽  
Oral Cancer ◽  
Diagnostic Accuracy ◽  
False Positive ◽  
Characteristic Curve ◽  
False Positive Rate ◽  
False Negative ◽  
High Sensitivity ◽  
Summary Receiver Operating Characteristic ◽  
True Negative

Objectives To evaluate the accuracy of methylene blue (MB) for diagnosing oral cancer and precancer. Data Sources PubMed, Cochrane Database, Embase, Web of Science, SCOPUS, and Google Scholar. Review Methods Two authors working independently reviewed 6 databases from their dates of inception until April 2020. Studies exploring oral mucosal disorders as detected by MB were assessed. True-positive, true-negative, false-positive, and false-negative data were extracted for each study. Methodological quality was evaluated with the Quality Assessment of Diagnostic Accuracy Studies tool (v 2). Results Seven prospective and retrospective studies (N = 493) were included. The diagnostic odds ratio of MB was 20.017 (95% CI, 10.65-37.63, I2 = 23%). The area under the summary receiver operating characteristic curve was 0.699. Sensitivity was 0.903 (95% CI, 0.84-0.94, I2 = 54%), and specificity was 0.68 (95% CI, 0.60-0.75, I2 = 0%). The correlation between the sensitivity and the false-positive rate was –0.17, indicating an absence of heterogeneity. Conclusions Regarding diagnostic accuracy, MB had high sensitivity but low specificity, suggesting that it cannot be recommended as a replacement for the currently used standard of a scalpel biopsy with histologic assessment. Instead, it should be used as an adjunct to conventional assessment because of its low toxicity and price.

Comparison of Narrowband Imaging and White-Light Endoscopy for Diagnosis and Screening of Nasopharyngeal Cancer

2021 ◽  
pp. 019459982110296
Author(s):  
Do Hyun Kim ◽  
Min Hyeong Lee ◽  
Seulah Lee ◽  
Sung Won Kim ◽  
Se Hwan Hwang
Keyword(s):  
Diagnostic Accuracy ◽  
White Light ◽  
False Positive ◽  
Characteristic Curve ◽  
False Positive Rate ◽  
False Negative ◽  
Nasopharyngeal Cancer ◽  
True Negative ◽  
White Light Endoscopy ◽  
Narrowband Imaging

Objectives We compared the diagnostic accuracies of narrowband imaging and white-light endoscopy in the detection of nasopharyngeal cancer. Data Sources Six databases (PubMed, Cochrane Database, Embase, Web of Science, SCOPUS, and Google Scholar). Review Methods The 6 databases were thoroughly reviewed by 2 authors (working independently) from their dates of inception to December 2019. Nasopharyngeal mucosal or vascular changes detected by narrowband imaging were compared to those detected by white-light endoscopy. The authors extracted true-positive, true-negative, false-positive, and false-negative parameters for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. The extent of interrater agreement was assessed. Results Eighteen prospective or retrospective studies were included. The diagnostic odds ratio of narrowband imaging was 77.560 (95% confidence interval [CI], 37.424-160.739). The area under the summary receiver operating characteristic curve was 0.926. The sensitivity, specificity, and negative predictive value were 0.871 (95% CI, 0.808-0.915), 0.905 (95% CI, 0.816-0.953), and 0.955 (95% CI, 0.906-0.979), respectively. The correlation between sensitivity and the false-positive rate was 0.284, indicating that heterogeneity was absent. Narrowband imaging exhibited moderate interrater reliability (0.7037; 95% CI, 0.6558-0.746). Subgroup analysis showed that vascular patterns revealed by endoscopy in a screened subgroup were significantly more diagnostically accurate than mucosal patterns used for surveillance of a recurrent cancer subgroup. Conclusions Narrowband imaging exhibits high diagnostic accuracy and should be used in the diagnostic workup of nasopharyngeal cancer. However, further studies are necessary to confirm our results.

scholarly journals Diagnostic Value of MRI for Detecting Recurrent Soft-Tissue Sarcoma in a Long-Term Analysis at a Multidisciplinary Sarcoma Center

2020 ◽  
Author(s):  
Sam Sedaghat ◽  
Maya Sedaghat ◽  
Jens Meschede ◽  
Olav Jansen ◽  
Marcus Both
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Diagnostic Accuracy ◽  
False Positive ◽  
False Negative ◽  
True Positive ◽  
Primary Tumors ◽  
Negative Results

Abstract Background: To assess the long-term diagnostic accuracy of MRI for detecting recurrent soft-tissue sarcoma at a multidisciplinary sarcoma center.Methods: In all, 1055 postoperative follow-up MRIs of 204 patients were included in the study. MRI follow-up scans were systematically reviewed for true-positive/-negative and false-positive/-negative results in detecting recurrent tumor. Available pathological reports and follow-up MRIs were set as reference. Results: The median age of the patients was 55.3±18.2 years. Of the patients, 34.8% presented with recurrences. Here, 65 follow-up scans were true positive, 23 false positive, 6 false negative, and 961 true negative. The overall sensitivity and specificity of MRI for detecting recurrences were 92% and 98%, respectively, with an accuracy of 97%. For intramuscular lesions and after surgery alone the sensitivity was higher (95% and 97%) than for subcutaneous lesions and surgery with additional radiation therapy (83% and 86%, respectively), at similarly high specificities (96-98%). The 6 false-negative results were found in streaky (n=2) and small ovoid/nodular (n=4) recurring lesions. The false-positive lesions imitated streaky (n=14), ovoid/nodular (n=8), and polycyclic/multilobulated recurring tumors (n=1). All false-positive results were found in patients in whom the primary tumors were polycyclic/multilobulated in appearance.Conclusion: MRI shows a high diagnostic accuracy for detecting recurrent STS, with a high sensitivity and specificity. The diagnostic accuracy decreases in subcutaneous lesions and after surgery with radiation therapy, compared to intramuscular lesions and surgery alone. Radiologists should pay particular attention to streaky and small ovoid/nodular recurring lesions and patients with polycyclic/multilobulated primary tumors.

Diagnostic accuracy of seven radiographic views, alone and in combination, for diagnosis of pectoral girdle fractures in wild passerines after window collisions

2022 ◽  
pp. 1-6
Author(s):  
Crystal L. Matt ◽  
Nicola Di Girolamo ◽  
Ruth M. Hallman ◽  
Keith L. Bailey ◽  
Timothy J. O’Connell ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
False Positive ◽  
Clinical Relevance ◽  
False Negative ◽  
Pectoral Girdle ◽  
Blinded Observer ◽  
Positive Results ◽  
Limited Accuracy

Abstract OBJECTIVE To determine the prevalence of pectoral girdle fractures in wild passerines found dead following presumed window collision and evaluate the diagnostic accuracy of various radiographic views for diagnosis of pectoral girdle fractures. SAMPLE Cadavers of 103 wild passerines that presumptively died as a result of window collisions. PROCEDURES Seven radiographic projections (ventrodorsal, dorsoventral, lateral, and 4 oblique views) were obtained for each cadaver. A necropsy was then performed, and each bone of the pectoral girdle (coracoid, clavicle, and scapula) was evaluated for fractures. Radiographs were evaluated in a randomized order by a blinded observer, and results were compared with results of necropsy. RESULTS Fifty-six of the 103 (54%) cadavers had ≥ 1 pectoral girdle fracture. Overall accuracy of using individual radiographic projections to diagnose pectoral girdle fractures ranged from 63.1% to 72.8%, sensitivity ranged from 21.3% to 51.1%, and specificity ranged from 85.7% to 100.0%. The sensitivity of using various combinations of radiographic projections to diagnose pectoral girdle fractures ranged from 51.1% to 66.0%; specificity ranged from 76.8% to 96.4%. CLINICAL RELEVANCE Radiography alone appeared to have limited accuracy for diagnosing fractures of the bones of the pectoral girdle in wild passerines after collision with a window. Both individual radiographic projections and combinations of projections resulted in numerous false negative but few false positive results.

scholarly journals Viewpoint: Diagnosis in primary care: probabilistic reasoning

2012 ◽  
Vol 4 (2) ◽  
pp. 166 ◽  
Author(s):  
Bruce Arroll ◽  
GM Allan ◽  
C Raina Elley ◽  
Tim Kenealy ◽  
James McCormack ◽  
...  
Keyword(s):  
Primary Care ◽  
Diagnostic Accuracy ◽  
False Positive ◽  
Probabilistic Reasoning ◽  
False Negative ◽  
Post Test ◽  
Low Prevalence ◽  
Post Test Probability ◽  
Test Probability ◽  
Rule Out

This article develops the concept of probabilistic reasoning as one of the techniques clinicians use in making a diagnosis. We develop the concept that every question and every examination is a diagnostic test ultimately leading to a rule in or rule out of a diagnosis. We also develop the concept of pre-test probability pointing out that false positive tests are an issue in low-prevalence settings and false negative tests are a problem. Investigative tests work best in medium-prevalence settings. The purpose of taking a history and conducting an examination is to increase the pre-test probability to a point where either treatment is commenced or more expensive/time-consuming/dangerous tests are indicated. Pre-test probabilities on their own can be used to rule out conditions. We also show how pre-test probabilities relate to the Fagan nomogram which enables visualisation of large changes in post-test probabilities which can lead to treatment/further investigation. KEYWORDS: Likelihood ratio; pre-test and post-test probability; diagnostic accuracy; probabilistic reasoning

scholarly journals A Dynamic & Combined Framework for Predicting Phishing Attack

2020 ◽  
Vol 8 (6) ◽  
pp. 2294-2297
Keyword(s):  
False Positive ◽  
Web Applications ◽  
False Negative ◽  
Positive Proportion ◽  
Web Community ◽  
Phishing Detection ◽  
The Web

With the fast improvement of web applications, and with the solace gave by these web applications, web clients’ use this advantages, as it were, that they make practically the entirety of their everyday exercises, for example, newspaper reading, shopping, bill payment, ticket booking and entertainment with the assistance of the web. This wonder powers the clients of the web to get associated with the web for a drawn-out time and consequently it builds the odds of the clients to get trapped in the snare of phishing – an assault made by programmers to take delicate data by enticing the clients with rewarding offers at first and afterward diverting them to a fake website(which the client may not presume) where they can mislead the client by requesting that they present their credentials(usually clients present their credentials without realizing that these are phony offers made with a sole aim of taking delicate data ). Notwithstanding the caution and mindfulness given by the web community right now, and more phishing craftsman prevail in their attack. Likewise, these phishing craftsmen create novel attacks, for example, tab grabbing, site mirroring and so forth that draws in increasingly more web clients to be trapped in the snare of phishing. Anyway, numerous tools and methodologies have been created to forestall phishing and to caution clients orally and outwardly. Still, the achievement paces of the phishing attack stay high and furthermore the methodologies identified with phishing detection endures high false negative and false positive proportion. In this proposed system numerous mechanisms used to prevent phishing have been analyzed and a proficient system has been proposed to forestall phishing.

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