scholarly journals The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort

2020 ◽  
Vol 9 (10) ◽  
pp. 3374
Author(s):  
Qiuke Wang ◽  
Jos Runhaar ◽  
Margreet Kloppenburg ◽  
Maarten Boers ◽  
Johannes Bijlsma ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
General Practitioners ◽  
Secondary Care ◽  
Negative Likelihood Ratio ◽  
Final Diagnosis ◽  
Added Value ◽  
Early Osteoarthritis ◽  
Sensitivity Specificity ◽  
Radiographic Data

Objective: The purpose of this study was to evaluate the added value of radiographs for diagnosing knee osteoarthritis (KOA) by general practitioners (GPs) and secondary care physicians (SPs). Methods: Seventeen GPs and nineteen SPs were recruited to evaluate 1185 knees from the CHECK cohort (presenters with knee pain in primary care) for the presence of clinically relevant osteoarthritis (OA) during follow-up. Experts were required to make diagnoses independently, first based on clinical data only and then on clinical plus radiographic data, and to provide certainty scores (ranging from 1 to 100, where 1 was “certainly no OA” and 100 was “certainly OA”). Next, experts held consensus meetings to agree on the final diagnosis. With the final diagnosis as gold standard, diagnostic indicators were calculated (sensitivity, specificity, positive/negative predictive value, accuracy and positive/negative likelihood ratio) for all knees, as well as for clinically “certain” and “uncertain” knees, respectively. Student paired t-tests compared certainty scores. Results: Most diagnoses of GPs (86%) and SPs (82%) were “consistent” after assessment of radiographic data. Diagnostic indicators improved similarly for GPs and SPs after evaluating the radiographic data, but only improved relevantly in clinically “uncertain” knees. Radiographs added some certainty to “consistent” OA knees (GP 69 vs. 72, p < 0.001; SP 70 vs. 77, p < 0.001), but not to the consistent no OA knees (GP 21 vs. 22, p = 0.16; SP 20 vs. 21, p = 0.04). Conclusions: The added value of radiographs is similar for GP and SP, in terms of diagnostic accuracy and certainty. Radiographs appear to be redundant when clinicians are certain of their clinical diagnosis.

scholarly journals MRI versus CT and PET/CT in the Preoperative Assessment of Hodgkin and Non-Hodgkin Lymphomas

Hemato ◽  
2021 ◽  
Vol 2 (4) ◽  
pp. 635-644
Author(s):  
Francesca Maccioni ◽  
Alessandro Calabrese ◽  
Lucia Manganaro ◽  
Carlo de Felice ◽  
Sara Cardaccio ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Preoperative Assessment ◽  
Added Value ◽  
Pet Ct ◽  
Disease Staging ◽  
Total Body ◽  
Histological Confirmation ◽  
Sensitivity Specificity ◽  
Ct And Mri

(1) Background: The purpose of this study is to retrospectively compare CT, MRI, and PET/CT in detecting lymphadenopathies and extra-nodal lesions in lymphoma and in disease staging. (2) Methods: Inclusion criteria were the availability of TB (Total Body) CT and/or PET/CT performed before treatment; MRI performed no later than 2 weeks after TBCT; histological confirmation of lymphoma; clinical-diagnostic follow-up. Using these criteria, we included 64/353 patients with TBCT and MRI performed at our hospital; 20/64 had PET/CT performed in other hospitals. Histology and follow-up were gold standard. (3) Results: The sensitivity, specificity, and accuracy in lymph nodes detection was 84.5%, 94.4%, and 91% for CT and 95%, 98.9%, and 95.6% for MRI. High agreement was observed between CT and MRI regarding the number and size of positive lymph nodes and for disease staging. MRI identified eight more extra-nodal lesions than CT. In the subgroup of 20 patients, PET/CT did not show a significant superiority in sensitivity, specificity, accuracy, and staging ability than CT and MRI. (4) Conclusions: Our study demonstrates a mild superiority of MRI over CT in lymphoma staging. Although PET/CT remains the reference standard, MRI demonstrated a similar diagnostic accuracy, with the added value of being radiation-free.

Ultrasonography as a Guiding Method in Breast Micro-Calcification Vacuum-Assisted Biopsies

2015 ◽  
Vol 37 (05) ◽  
pp. 497-502 ◽  
Author(s):  
A. K. Keränen ◽  
M. Haapea ◽  
T. Rissanen
Keyword(s):  
Ductal Carcinoma ◽  
Final Diagnosis ◽  
Frequency Distributions ◽  
Technical Success Rate ◽  
Negative Results ◽  
Large Size ◽  
Stereotactic Method ◽  
Sensitivity Specificity ◽  
Higher Sensitivity

Abstract Purpose: To assess the visibility of breast micro-calcifications using ultrasonography (US) and the accuracy and clinical usefulness of vacuum-assisted biopsy (VAB) using US guidance (USVAB) as compared to stereotactic guidance (SVAB). Materials and Methods: The study material comprised 158 retrospectively reviewed micro-calcification cases examined with US before VAB. The pre-biopsy US positivity frequency distributions were calculated, and the sensitivity, specificity and accuracy of VAB determined by comparing VAB histology with the surgical pathology or a 12-month follow-up. Results: 158 US examinations yielded 80 positive and 78 negative results. US positivity correlated to a large size and a suspicious BI-RADS category of the calcifications. USVAB was performed in 49 cases with 61 % malignant, 12 % high-risk and 27 % benign results. The percentages for the 109 SVAB cases were 40 %, 28 % and 32 %, respectively. Specimen radiography demonstrated calcifications in 48 of the 49 (98 %) USVAB cases and in 107 of the 109 (98 %) SVAB cases. The overall accuracy of VAB was 94 % (USVAB 98 %, SVAB 94 %), the sensitivity was 88 % (USVAB 97 %, SVAB 83 %), and the specificity was 100 %. The higher sensitivity of USVAB was due to an accumulation of atypical hyperplasia diagnoses in the SVAB group. The final diagnosis was invasive ductal carcinoma in 21 US-positive and in 4 US-negative cases. Conclusion: Approximately 50 % of mammographically detected micro-calcifications could be detected with ultrasonography. US was found to be a valuable alternative guidance method for vacuum-assisted biopsy of micro-calcifications with a technical success rate and diagnostic accuracy well comparable to the stereotactic method.

scholarly journals Added Value of Chest CT in Suspected COVID-19: An Analysis of 239 Patients

2020 ◽  
Author(s):  
Daniel A. Korevaar ◽  
Ruud S. Kootte ◽  
Loek P. Smits ◽  
Joost G. van den Aardweg ◽  
Peter I. Bonta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Academic Medical Center ◽  
Final Diagnosis ◽  
Chest Ct ◽  
Added Value ◽  
Rt Pcr ◽  
Positive Serology ◽  
Academic Medical

Introduction: Clinicians have been struggling with the optimal diagnostic approach of patients with suspected COVID-19. We evaluated the added value of chest CT over RT-PCR alone. Methods: Consecutive adult patients with suspected COVID-19 presenting to the emergency department (Academic Medical Center, Amsterdam University Medical Centers, the Netherlands) from March 16th to April 16th were retrospectively included if they required hospital admission and underwent chest CT and RT-PCR testing for SARS-CoV-2 infection. The CO-RADS classification was used to assess the radiological probability of COVID-19, where a score of 1-2 was considered as negative, 3 as indeterminate, and 4-5 as positive. CT results were stratified by initial RT-PCR results. For patients with a negative RT-PCR but a positive CT, serology or multidisciplinary discussion after clinical follow-up constituted the final diagnosis. Results: 258 patients with suspected COVID-19 were admitted, of which 239 were included because they had both CT and RT-PCR testing upon admission. Overall, 112 patients (46.9%) had a positive initial RT-PCR, and 14 (5.9%) had a positive repeat RT-PCR. Of 127 patients with a negative or indeterminate initial RT-PCR, 38 (29.9% [95%CI 21.3-39.3%]) had a positive CT. Of these, 13 had a positive RT-PCR upon repeat testing, and 5 had positive serology. The remaining 20 patients were assessed in a multidisciplinary consensus meeting, and for 13 it was concluded that COVID-19 was &lsquo;very likely&rsquo;. Of 112 patients with a positive initial RT-PCR result, CT was positive in 104 (92.9% [95%CI 89.3-97.5%]). Conclusion: In a high-prevalence emergency department setting, chest CT showed high probability of COVID-19 (CO-RADS 4-5) in 29.9% of patients with a negative or indeterminate initial RT-PCR result. As the majority of these patients had proven or &lsquo;very likely&rsquo; COVID-19 after follow-up, we believe that CT helps in the identification of patients who should be admitted in isolation.

Restaging of patients with lymphoma

2008 ◽  
Vol 47 (01) ◽  
pp. 37-42 ◽  
Author(s):  
T. Pfluger ◽  
V. Schneider ◽  
M. Hacker ◽  
N. Bröckel ◽  
D. Morhard ◽  
...  
Keyword(s):  
Low Dose ◽  
Non Hodgkin Lymphoma ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Significant Difference ◽  
18F Fdg ◽  
Sensitivity Specificity ◽  
Fdg Pet Ct

SummaryAim: Assessment of the clinical benefit of i.v. contrast enhanced diagnostic CT (CE-CT) compared to low dose CT with 20 mAs (LD-CT) without contrast medium in combined [18F]-FDG PET/CT examinations in restaging of patients with lymphoma. Patients, methods: 45 patients with non-Hodgkin lymphoma (n = 35) and Hodgkin's disease (n = 10) were included into this study. PET, LD-CT and CECT were analyzed separately as well as side-by-side. Lymphoma involvement was evaluated separately for seven regions. Indeterminate diagnoses were accepted whenever there was a discrepancy between PET and CT findings. Results for combined reading were calculated by rating indeterminate diagnoses according the suggestions of either CT or PET. Each patient had a clinical follow-up evaluation for >6 months. Results: Region-based evaluation suggested a sensitivity/specificity of 66/93% for LD-CT, 87%/91% for CE-CT, 95%/96% for PET, 94%/99% for PET/LD-CT and 96%/99% for PET/CE-CT. The data for PET/CT were obtained by rating indeterminate results according to the suggestions of PET, which turned out to be superior to CT. Lymphoma staging was changed in two patients using PET/ CE-CT as compared to PET/LD-CT. Conclusion: Overall, there was no significant difference between PET/LD-CT and PET/CE-CT. However, PET/CE-CT yielded a more precise lesion delineation than PET/LD-CT. This was due to the improved image quality of CE-CT and might lead to a more accurate investigation of lymphoma.

Transvaginal Ultrasonography and Saline Infusion Sonography Compared to Hysteroscopy for Diagnosis of Intracavity Lesion: A 4-Year Experience in Suburban Referral Hospital

2020 ◽  
Vol 103 (6) ◽  
pp. 585-593
Keyword(s):  
Predictive Value ◽  
Final Diagnosis ◽  
Saline Infusion ◽  
Transvaginal Ultrasonography ◽  
Histopathological Diagnosis ◽  
Endometrial Polyps ◽  
Saline Infusion Sonography ◽  
Submucous Myoma ◽  
Kappa Value ◽  
Sensitivity Specificity

Objective: To evaluate the accuracy of transvaginal ultrasonography (TVS) and saline infusion sonography (SIS) in use for the diagnosis of endometrial polyps and submucous myoma compared to hysteroscopy. Histopathology was considered as the gold standard for final diagnosis. Materials and Methods: The present retrospective study was conducted at Bhumibol Adulyadej Hospital, Bangkok, Thailand between January 2014 and December 2017. Medical records of 150 patients who attended for hysteroscopy and histopathological diagnosis were reviewed. The accuracy of TVS and SIS for the diagnosis of endometrial polyps and submucous myoma were determined. Results: Out of 150 enrolled cases, endometrial polyp was the most frequent hysteroscopic finding in participants of the present study (92/150). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of TVS, SIS, and hysteroscopy compared to pathologic reports for detection endometrial polyps were 71.7% versus 93.5% versus 97.8%, 38.5% versus 52.2% versus 68.2%, 80.5% versus 88.7% versus 92.8%, 27.8% versus 66.7% versus 88.2%, and 64.4% versus 85.2% versus 92.1%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of TVS, SIS, and hysteroscopy for detection of submucous myoma were 81.6% versus 92.1% versus 94.7%, 66.7% versus 86.9% versus 100%, 77.5% versus 92.1% versus 100%, 72.0% versus 86.9% versus 90.9%, and 75.4% versus 90.2% versus 96.6%, respectively. The kappa value from TVS, SIS, and hysteroscopy when the histopathologic reports were overall intrauterine abnormalities, endometrial polyps and submucous myoma were 0.45/0.43/0.72, 0.77/0.76/0.89, and 0.92/0.92/1.00, respectively. Conclusion: Sensitivity, specificity, PPV, NPV, accuracy, and kappa value of SIS for detecting endometrial polyps and submucous myoma were better than TVS. Keywords: Ultrasonography, Saline infusion sonography, Hysteroscopy, Accuracy

Pengurangan Kadar Minyak Pada Abon Ikan Produksi Savitri Dan Tiaras Dengan Penerapan Alat Peniris Serbaguna Di Kota Kupang

2018 ◽  
Vol 2 (2) ◽  
pp. 20
Author(s):  
Muntasir Muntasir ◽  
Pius Weraman
Keyword(s):  
Raw Material ◽  
Added Value ◽  
Filter Model ◽  
Simulation Tools ◽  
The Public ◽  
Fish Meat ◽  
Efficiency Increase ◽  
Main Components ◽  
Design And Manufacture

Community Partnership Program in small home industry of making fish floss brand "Savitri" and "Tiaras" inKupang city in the form of application of electric centrifugation filter model has been implemented. One of the problemsin the production of Savitri and Tiaras fish floss is that there is still a lot of oil in the frying product which is only drainedon a simple sieve and then placed for some time on traditional tools of filter and paper that can cause low quality and lowquality, so it is necessary to reduce the oil yield frying fish floss product. In order to increase the added value and sellingvalue of the products, it is necessary synergy between Universities and Partners in the form of application of the results ofscience and technology to the public. The main components of the composer of the versatile filter are the cylindrical plateas the bucket of the filter, the cylinder filter, the electric dynamo as the centrifuge system rotator and the load-bearingconstruction. The method of this program is the provision of materials, design and manufacture of tools, demonstrationtools and the provision of a versatile filter cylinder system centrifuge model by the team, simulation tools, specialcounseling at the location of partners and suggestions as a follow-up in the endurance of production. The output of thisprogram can provide added value in the form of the use of this tool can improve labor efficiency, increase productivitypartners by producing 40 kg to 50 kg raw material, raw fish marlin, fish meat after cleaning, processed, fried, in andpacked into 80-100 packs of fish floss with the price of Rp. 40,000.00 per package weighing 250 grams. With estimatedpartners will earn a profit of Rp 3,200,000 - 4,000,000.00 per production or 12,800,000.00 - 16,000,000.00 per month incash and consumptions, as well as the abundance of non-greasy, clean and hybrid fish products

scholarly journals Early recognition of PIMS-TS: a single centre retrospective review

2021 ◽  
Vol 5 (1) ◽  
pp. e001011
Author(s):  
Roshni Mistry ◽  
Nicola Scanlon ◽  
James Hibberd ◽  
Fionnghuala Fuller
Keyword(s):  
Early Recognition ◽  
Febrile Illness ◽  
Final Diagnosis ◽  
University Hospital ◽  
Single Centre ◽  
Retrospective Case ◽  
Reactive Protein ◽  
Review Reports ◽  
Specific Symptoms

IntroductionResearch into paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) has focused on tertiary level management. This review reports on symptoms and investigations at presentation.MethodsSingle centre retrospective case note analysis of patients fulfilling PIMS-TS diagnostic criteria from March to May 2020 in a London district level university hospital.ResultsSix patients presented in the week prior to their final diagnosis with fever and non-specific symptoms. Raised C-reactive protein (CRP), lymphopenia and hyponatraemia were noted. Kawasaki-like symptoms were under-represented in all patients.InterpretationThe results suggest that a proportion of children with early PIMS-TS present with a non-specific febrile illness and abnormal blood results. Further research is needed to determine the most appropriate identification and follow-up of these children.

scholarly journals Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis

2021 ◽  
Vol 8 (1) ◽  
pp. e000501
Author(s):  
Manu K Nayar ◽  
Noor L H Bekkali ◽  
David Bourne ◽  
Sophie Young ◽  
John S Leeds ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Secondary Care ◽  
Multiorgan Failure ◽  
Tertiary Care ◽  
Endoscopic Drainage ◽  
Hub And Spoke ◽  
Specialist Nurse ◽  
Icu Stay

ObjectiveSevere acute pancreatitis (SAP) is associated with high mortality (15%–30%). Current guidelines recommend these patients are best managed in a multidisciplinary team setting. This study reports experience in the management of SAP within the UK’s first reported hub-and-spoke pancreatitis network.DesignAll patients with SAP referred to the remote care pancreatitis network between 2015 and 2017 were prospectively entered onto a database by a dedicated pancreatitis specialist nurse. Baseline characteristics, aetiology, intensive care unit (ICU) stay, interventions, complications, mortality and follow-up were analysed.Results285 patients admitted with SAP to secondary care hospitals during the study period were discussed with the dedicated pancreatitis specialist nurse and referred to the regional service. 83/285 patients (29%; 37 male) were transferred to the specialist centre mainly for drainage of infected pancreatic fluid collections (PFC) in 95% (n=79) of patients. Among the patients transferred; 29 (35%) patients developed multiorgan failure with an inpatient mortality of 14% (n=12/83). The median follow-up was 18.2 months (IQR=11.25–35.51). Multivariate analysis showed that transferred patients had statistically significant longer overall hospital stay (p<0.001) but less ICU stay (p<0.012).ConclusionThis hub-and-spoke model facilitates the management of the majority of patients with SAP in secondary care setting. 29% warranted transfer to our tertiary centre, predominantly for endoscopic drainage of PFCs. An evidence-based approach with a low threshold for transfer to tertiary care centre can result in lower mortality for SAP and fewer days in ICU.

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