scholarly journals The slipping slipper sign: a simple test with high specificity and positive predictive value for peripheral neuropathy among diabetic patients

2012 ◽  
Vol 2 (2) ◽  
pp. 51 ◽  
Author(s):  
Krystal A.T. Gayle ◽  
Marshall K. Tulloch-Reid ◽  
Rainford J. Wilks ◽  
Trevor S. Ferguson
Keyword(s):  
Peripheral Neuropathy ◽  
Positive Predictive Value ◽  
Diabetic Neuropathy ◽  
Predictive Value ◽  
High Specificity ◽  
Diabetic Patients ◽  
Simple Test ◽  
Diabetes Clinic ◽  
Sensitivity Specificity ◽  
Single Question

This study evaluated the ability of the slipping slipper sign (defined as unknowingly losing a slipper while walking) to identify diabetic neuropathy in Jamaican patients. A single question was used to ascertain the presence of the slipping slipper sign (SSS) among 69 patients attending a diabetes clinic. Nurses assessed pain, vibration and pressure perception among the same patients in order to detect diabetic neuropathy. The sensitivity, specificity and positive predictive value for the SSS were calculated. Eight participants (men=5, women=3) reported positive SSS. The SSS had a sensitivity of 28.6%, specificity of 100% and positive predictive value (PPV) 100% for neuropathy on at least one of the three tests. These findings indicate that the SSS has high specificity and PPV for diabetic neuropathy but the sensitivity is low. The sign may be a useful adjuvant to conventional methods of screening for severe neuropathy

Diagnostic accuracy of monofilament test to detect diabetic neuropathy

2021 ◽  
Vol 10 (1) ◽  
pp. 20-25
Author(s):  
Sujan Shrestha ◽  
Mamen Prasad Gorhaly ◽  
Manil Ratna Bajracharya
Keyword(s):  
Peripheral Neuropathy ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diabetic Peripheral Neuropathy ◽  
Perception Threshold ◽  
Sensitivity Specificity ◽  
Vibration Perception ◽  
Monofilament Test

Background Diabetic peripheral neuropathy (DPN) is a significant independent risk factor for diabetic foot, and an effective screening instrument is required to diagnose DPN early to prevent future ulceration and amputation. This study aims to determine the diagnostic accuracy of monofilament test to detect diabetic peripheral neuropathy. Methods This cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital, Mahabouddha, Kathmandu from February 2016 to January 2017. A total of 96 diabetic patients attending inpatient and outpatient Department were selected. Diabetic peripheral neuropathy was assessed by measurement of loss of protective sensation (LOPS) by monofilament test and compared with vibration perception threshold by standard biothesiometer. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were calculated. Results The prevalence of diabetic peripheral neuropathy was 26%. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were found to be 92.0%, 95.8%, 88.5% and 97.1% respectively. There was strong association between LOPS by monofilament and vibration perception threshold by biothesiometer. Conclusion This study showed a strong diagnostic accuracy of monofilament test to detect DPN when compared with biothesiometer. As monofilament test is a cheap, easily available, and portable, it can be used in the periphery where biothesiometer is not available.  

scholarly journals Clinical Performance of the Spot Vision Photo Screener before and after Induction of Cycloplegia in Children

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Konuralp Yakar
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Clinical Performance ◽  
High Specificity ◽  
Screening Criteria ◽  
Predictive Values ◽  
Before And After ◽  
Sensitivity Specificity ◽  
Vision Screener

Aim. To compare the clinical performance of the Spot Vision Screener used to detect amblyopia risk factors (ARFs) in children before and after induction of cycloplegia; the children were referred because they met the screening criteria of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Methods. The Spot Vision Screener and a standard autorefractometer were used to examine 200 eyes of 100 children aged 3–10 years, before and after cycloplegia induction, in terms of ARFs. Sensitivity, specificity, and positive and negative predictive values for the detection of significant refractive errors were measured using the AAPOS referral criteria. It was explored that Spot Screener data were affected by cycloplegia. The extent of agreement between cycloplegic/noncycloplegic photoscreening data and cycloplegic autorefraction measurements was assessed using Wilcoxon and Spearman correlation analyses. Results. The Spot’s sensitivity was improved from 60.9% to 85.3% and specificity from 94.9% to 87.4% with cycloplegia compared to cycloplegic standard autorefractometer results. The positive predictive value of Spot was 75.7%, and the negative predictive value was 90.4% without cycloplegia. With cycloplegia, the positive predictive value of Spot was 63.6% and the negative predictive value was 95.8%. Conclusions. The Spot Screener afforded moderate sensitivity and high specificity prior to cycloplegia. The sensitivity and negative predictive value improved after induction of cycloplegia. Examiners should be aware of the effects of cycloplegia on their findings.

Utility of Squash Cytology in Spinal Lesions with Special Reference to Ki67 Immunostain

2019 ◽  
Vol 63 (5) ◽  
pp. 424-430
Author(s):  
Debashis Chakrabarty ◽  
Shubhamitra Chaudhuri ◽  
Priyanka Maity ◽  
Uttara Chatterjee ◽  
Subhasis Ghosh
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
High Specificity ◽  
Histopathological Diagnosis ◽  
Spinal Tumours ◽  
Who Grade ◽  
Spinal Lesions ◽  
Sensitivity Specificity ◽  
A Prospective Study

Background: Squash cytology is of significant importance in intraoperative consultation of central nervous system (CNS) pathology. There are several studies on squash cytology of CNS lesions, and only a few of them deal with spinal lesions alone. Aims: (1) To evaluate intraoperative squash cytology of spinal lesions. (2) To correlate cytological diagnosis with histopathological diagnosis and assess the diagnostic accuracy. (3) To study Ki67 expression on squash smears and determine whether it can assist in grading spinal tumours on cytology. Materials and Methods: A prospective study was conducted on 68 patients with clinico-radiologically diagnosed lesions of the spine. Intraoperative squash smears were stained with haematoxylin-eosin (H&E) stain, Papanicolaou (Pap) stain, and May-Grünwald-Giemsa (MGG) stain. Subsequently, histological diagnosis was made. Ki67 immunostaining was performed on squash smears and histology sections. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of squash cytology in spinal lesions were 84.6, 100, 100, 23.1, and 80.88%, respectively. On immunocytochemistry, the mean Ki67 labelling indices for grade I, II, and III tumours were 0, 0.33 and 9%, respectively. Conclusion: Squash smear cytology is a rapid intraoperative technique for diagnosing spinal lesions, with high specificity and high positive predictive value. It is more effective in diagnosing neoplasms than non-neoplastic lesions. Ki67 immunostaining can be done on cytology smears to effectively differentiate between WHO grade I and grade II spinal tumours.

scholarly journals OR07-05 Is Urinary Calcium the Only Predictor of Nephrolithiasis in Patients with Asymptomatic Primary Hyperparathyroidism?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Federica Saponaro ◽  
Filomena Cetani ◽  
Laura Mazoni ◽  
Matteo Apicella ◽  
Marco Scalese ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Multivariate Analyses ◽  
International Workshop ◽  
High Specificity ◽  
Risk Profile ◽  
Urinary Calcium ◽  
Youden Index ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Abstract The 4th International Workshop for the management of asymptomatic PHPT included, among the criteria for parathyroidectomy, the presence of hypercalciuria (dUCa> 400 mg/day) and increased biochemical stone risk profile. The aim of the present study was to evaluate the biochemical stone risk profile in 176 consecutive patients (143 females and 33 males) with asymptomatic PHPT. We recorded clinical and biochemical data, including 24 hours urinary measurements of the following parameters: volume and pH, creatinine, calcium, magnesium, sodium, potassium, ammonium, uric acid, oxalate, citrate, phosphate, inorganic sulphate and chloride and kidney ultrasound. In our cohort dUCa> 400mg/day showed a low sensitivity and positive predictive value (PPV) for nephrolithiasis with high specificity (46.2, 32.7, 73.0% respectively), while hypercalciuria by 4 mg/kg/bw (d-UCa>4mg/kg) had a high sensibility, with low PPV and specificity (79.5, 27.7, 40.1%) Daily hypomagnesuria (d-HypoMg), but not any other urinary parameter, was an independent predictor of nephrolithiasis in the univariate (OR 2.97 CI 1.27-7.09 P=0.014) and multivariate analyses adjusting for age, sex, BMI, and eGFR (OR 3.13 CI 1.17-8.42 P=0.02). d-HypoMg was relatively lower in the regression analysis with urinary calcium in patients with nephrolithiasis compared with those without. The mean ratio between (dUCa) and (dUMg) was higher in patients with nephrolithiasis compared with those without (4.6±2.0 vs 3.3±4.1; P<0.001). In the univariate and multivariate analyses the dUCa/dUMg ratio was a significant predictor of nephrolithiasis [OR 4.9 (2.3-10.5); P<0.001; OR 5.3 (2.4-11.6), P<0.001, respectively]. The AUC using the dUCa/dUMg ratio as variables was 0.69 (CI 0.60-0.79; P<0.0001). The best cut-off value, set at the highest Youden index, was equal to 4.0, with a sensitivity of 59.0% and a specificity of 77.4%. In patients with hypercalciuria (>400 mg/24-hour) dUMg was positively correlated with dUCa in those without nephrolithiasis (r=0.50, β=0.2, P=0.002) but not in those with nephrolithiasis (r=0.05, β= 0.014; P=0.8). In patients without hypercalciuria we found that hypomagnesuria remained a predictor of nephrolithiasis using either 400 mg/die (P=0.002, OR 5.12 (1.84-14.24) or 4 mg/kg bw (P=0.014, OR 6.24 (1.45-26.8). Moreover, the OR for nephrolithiasis improved using the combination of d-HypoMg with d-UCa>4mg/kg (OR 8.12, CI 1.92-34.18, P=0.004), but not with dUCa> 400mg/day. The current urinary calcium threshold of >400 mg/24-hour has a low sensitivity in detecting nephrolithiasis; our data suggest that sensitivity, specificity and positive predictive value could be improved including dUMg, dUCa/dUMg ratio and the combination of d-HypoMg with d-UCa>4mg/kg in the stone risk evaluation.

scholarly journals Accuracy of ultrasonography for differentiating between simple and complex appendicitis in children

2021 ◽  
Author(s):  
David J. Nijssen ◽  
Paul van Amstel ◽  
Joost van Schuppen ◽  
Laurens D. Eeftinck Schattenkerk ◽  
Ramon R. Gorter ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Laboratory Data ◽  
Clinical Signs ◽  
Simple Test ◽  
The Mean ◽  
Sensitivity Specificity ◽  
Time Of Operation

Abstract Purpose Accurate differentiation between simple and complex appendicitis is important since differences in treatment exist. This study aimed to assess the accuracy of ultrasonography in differentiating between simple and complex appendicitis. Methods Data from children aged < 18 years who underwent appendectomy between the 1st of January 2013 and the 1st of January 2018 were analyzed retrospectively. Ultrasonography reports of eligible children were divided into simple (test negative) and complex appendicitis (test positive) based on predefined criteria and compared to a gold standard (a combination of predefined perioperative and histopathological criteria). Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated to measure ultrasonographic accuracy in differentiating between simple and complex appendicitis. Results 176 children were eligible for inclusion. The mean age at the time of operation was 10.1 ± SD 4.6 years. 84 (47.7%) children had simple appendicitis and 92 (52.3%) had complex appendicitis. The use of ultrasonography yielded a sensitivity: 46%, specificity: 90%, PPV: 84%, and NPV: 60%. Conclusion Ultrasonography as standalone modality is not suitable for differentiating between simple and complex appendicitis in children. To improve preoperative differentiation, other variables such as clinical signs and laboratory data are necessary in conjunction with ultrasonography findings.

Symptomatic Treatment of Pain-Related Pediatric Functional Gastrointestinal Disorders in a Biopsychosocial Construct, and a Validity Study of Rome III Criteria

2021 ◽  
Vol 60 (6-7) ◽  
pp. 304-313
Author(s):  
Shailender Madani ◽  
Rohit Madani ◽  
Suchi Parikh ◽  
Ahila Manivannan ◽  
Wilma R. Orellana ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Functional Gastrointestinal Disorders ◽  
High Specificity ◽  
Symptomatic Treatment ◽  
Gastrointestinal Disorders ◽  
Organic Disease ◽  
Rome Iii Criteria ◽  
Rome Criteria ◽  
Rome Iii

Our study aims to assess improvement with symptomatic treatment of pain-related functional gastrointestinal disorders (FGIDs) in a biopsychosocial construct and evaluate validity of Rome III criteria. Children with chronic abdominal pain diagnosed with an FGID or organic disease were followed for 1 year: 256/334 were diagnosed with an FGID and 78/334 were diagnosed with a possible organic disease due to alarm signs or not meeting Rome III criteria. After 1 year, 251 had true FGID and 46 had organic diseases. Ninety percent of FGID patients improved with symptomatic treatment over an average of 5.4 months. With a 95% confidence interval, Rome criteria predicted FGIDs with sensitivity 0.89, specificity 0.90, positive predictive value 0.98, and negative predictive value 0.59. We conclude that symptomatic treatment of pain-related FGIDs results in clinical improvement and could reduce invasive/expensive testing. Rome III criteria’s high specificity and positive predictive value suggest they can rule in a diagnosis of FGID.

scholarly journals Foundational Statistical Principles in Medical Research: Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 503
Author(s):  
Thomas F. Monaghan ◽  
Syed N. Rahman ◽  
Christina W. Agudelo ◽  
Alan J. Wein ◽  
Jason M. Lazar ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Medical Literature ◽  
Disease Prevalence ◽  
Positive Test Result ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
Test Result ◽  
Test Probability

Sensitivity, which denotes the proportion of subjects correctly given a positive assignment out of all subjects who are actually positive for the outcome, indicates how well a test can classify subjects who truly have the outcome of interest. Specificity, which denotes the proportion of subjects correctly given a negative assignment out of all subjects who are actually negative for the outcome, indicates how well a test can classify subjects who truly do not have the outcome of interest. Positive predictive value reflects the proportion of subjects with a positive test result who truly have the outcome of interest. Negative predictive value reflects the proportion of subjects with a negative test result who truly do not have the outcome of interest. Sensitivity and specificity are inversely related, wherein one increases as the other decreases, but are generally considered stable for a given test, whereas positive and negative predictive values do inherently vary with pre-test probability (e.g., changes in population disease prevalence). This article will further detail the concepts of sensitivity, specificity, and predictive values using a recent real-world example from the medical literature.

scholarly journals Serum D-dimer level as a biomarker for identifying patients with isolated injury to prevent unnecessary whole-body computed tomography in blunt trauma care

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Rakuhei Nakama ◽  
Ryo Yamamoto ◽  
Yoshimitsu Izawa ◽  
Keiichi Tanimura ◽  
Takashi Mato
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
High Specificity ◽  
Whole Body ◽  
Cutoff Value ◽  
Whole Body Ct ◽  
Isolated Injury ◽  
D Dimer ◽  
Body Ct

Abstract Background Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT. Methods This single-center retrospective cohort study included patients with blunt trauma (2014–2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. “Isolated” injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels. Results Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815–0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 μg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0%) and positive predictive value (100.0%). Approximately 30% of patients had serum D-dimer levels below this cutoff value. Conclusion D-dimer level ≤ 2.5 μg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.

scholarly journals 3124 Early Electrographic Seizure Detection by Neuro ICU Nurses via Bedside Real-Time Quantitative EEG

2019 ◽  
Vol 3 (s1) ◽  
pp. 38-38
Author(s):  
Safa Kaleem ◽  
Christa B. Swisher
Keyword(s):  
Positive Predictive Value ◽  
Real Time ◽  
Predictive Value ◽  
Quantitative Eeg ◽  
University Hospital ◽  
Duke University ◽  
Study Population ◽  
Time To Detection ◽  
Sensitivity Specificity ◽  
Improve Patient

OBJECTIVES/SPECIFIC AIMS: 1. Determine positive predictive value, negative predictive value, sensitivity, and specificity of Neuro ICU nurse interpretation of real-time bedside qEEG. 2. Determine difference in time to detection of first seizure between Neuro ICU nurse qEEG interpretation and EEG fellow reads of cEEG. 3. Determine what qualities of seizures make detection by neuro ICU nurses more or less likely – e.g. duration of seizures, type of seizures, spatial extent of seizures. METHODS/STUDY POPULATION: Recruit neuro ICU nurses taking care of 150 patients admitted to the Neuro ICU at Duke University Hospital who are initiated on cEEG monitoring. Nurses will be consented for their participation in the study. Neuro ICU nurses will evaluate the qEE RESULTS/ANTICIPATED RESULTS: From literature estimates of a 20% seizure prevalence in critical care settings, we hope to have 30 patients with seizures and 120 without. Based on prior study in the Duke Neuro ICU, we hypothesize that Neuro ICU nurses will have sensitivity and DISCUSSION/SIGNIFICANCE OF IMPACT: This is the first prospective study of neuro ICU nurse interpretation of real-time bedside qEEG in patients with unknown NCSE/NCS presence. If nurse sensitivity, specificity, and positive predictive value are clinically useful, which we deem would be so at a sensitivity of 70% or greater, with acceptable false alarm rate, nurse readings of qEEG could significantly decrease the time to treatment of seizures in the Neuro ICU patient population, and perhaps could improve patient outcomes.

Drawing the line in the Edinburgh Postnatal Depression Scale (EPDS): a vital decision

2011 ◽  
Vol 23 (1) ◽  
Author(s):  
Dagmar Lagerberg ◽  
Margaretha Magnusson ◽  
Claes Sundelin
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Postnatal Depression ◽  
Edinburgh Postnatal Depression Scale ◽  
Depression Scale ◽  
Child Interaction ◽  
Mother Child Interaction ◽  
Problem Behaviours ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Abstract Background: The Edinburgh Postnatal Depression Scale (EPDS) is widely used in early child health care. This study examined the appropriateness of the recommended EPDS cut-off score 11/12. Methods: Two main analyses were performed: 1. Associations between EPDS scores and maternal health behaviour, stress, life events, perceived mother-child interaction quality and child behaviour. 2. Screening parameters of the EPDS, i.e., sensitivity, specificity and positive predictive value. EPDS scores were available for 438 mothers and maternal questionnaires for 361 mothers. Results: Already in the EPDS score intervals 6–8 and 9–11, there were notable adversities, according to maternal questionnaires, in stress, perceived quality of mother-child interaction, perceived child difficultness and child problem behaviours. Using maternal questionnaire reports about sadness/distress postpartum as standard, the recommended EPDS cut-off score 11/12 resulted in a very low sensitivity (24%). The cut-off score 6/7 yielded a sensitivity of 61%, a specificity of 82% and a positive predictive value of 61%. Conclusions: In terms of both clinical relevance and screening qualities, an EPDS cut-off score lower than 11/12 seems recommendable.

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