scholarly journals Facilitating Institutional Oversight and Program Improvement Through Educational Competency Committees

2016 ◽  
Vol 8 (3) ◽  
pp. 384-389 ◽  
Author(s):  
Kathryn M. Andolsek ◽  
Rhea F. Fortune ◽  
Alisa Nagler ◽  
Chrystal Stancil ◽  
Catherine Kuhn ◽  
...  
Keyword(s):  
Professional Development ◽  
Best Practices ◽  
Predictive Value ◽  
Program Improvement ◽  
Total Cost ◽  
Program Evaluations ◽  
Special Review ◽  
Sensitivity Specificity ◽  
The Cost ◽  
Institutional Oversight

ABSTRACT  The Accreditation Council for Graduate Medical Education (ACGME) requires programs to engage annually in program evaluation and improvement.Background  We assessed the value of creating educational competency committees (ECCs) that use successful elements of 2 established processes—institutional special reviews and institutional oversight of annual program evaluations.Objective  The ECCs used a template to review programs' annual program evaluations. Results were aggregated into an institutional dashboard. We calculated the costs, sensitivity, specificity, and predictive value by comparing programs required to have a special review with those that had ACGME citations, requests for a progress report, or a data-prompted site visit. We assessed the value for professional development through a participant survey.Methods  Thirty-two ECCs involving more than 100 individuals reviewed 237 annual program evaluations over a 3-year period. The ECCs required less time than internal reviews. The ECCs rated 2 to 8 programs (2.4%–9.8%) as “noncompliant.” One to 13 programs (1.2%–14.6%) had opportunities for improvement identified. Institutional improvements were recognized using the dashboard. Zero to 13 programs (0%–16%) were required to have special reviews. The sensitivity of the decision to have a special review was 83% to 100%; specificity was 89% to 93%; and negative predictive value was 99% to 100%. The total cost was $280 per program. Of the ECC members, 86% to 95% reported their participation enhanced their professional development, and 60% to 95% believed the ECC benefited their program.Results  Educational competency committees facilitated the identification of institution-wide needs, highlighted innovation and best practices, and enhanced professional development. The cost, sensitivity, specificity, and predictive value indicated good value.Conclusions

The Importance of Surgeon-reviewed Computed Tomography for Incisional Hernia Detection: A Prospective Study

2014 ◽  
Vol 80 (7) ◽  
pp. 720-722 ◽  
Author(s):  
Rebeccah B. Baucom ◽  
William C. Beck ◽  
Michael D. Holzman ◽  
Kenneth W. Sharp ◽  
William H. Nealon ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Incisional Hernia ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Radiology Report ◽  
Incisional Hernias ◽  
Radiology Reports ◽  
Sensitivity Specificity ◽  
A Prospective Study ◽  
The Cost

Patients with incisional hernias or abdominal pain are frequently referred with abdominal computed tomography (CT) scans. The purpose of this study was to determine the sensitivity and specificity of a CT radiology report for the detection of incisional hernias. General surgery patients with a history of an abdominal operation and a recent viewable abdominal CT scan were enrolled prospectively. Patients with a stoma, fistula, or soft tissue infection were excluded. The results of the radiology reports were compared with blinded, surgeon-interpreted CT for each patient. Testing characteristics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. One hundred eighty-one patients were enrolled with a mean age of 54 years. Sixty-eight per cent were women. Hernia prevalence was 55 per cent, and mean hernia width was 5.2 cm. The radiology report had a sensitivity and specificity of 79 per cent and 94 per cent, respectively, for hernia diagnosis. The PPV and NPV were 94 and 79 per cent, respectively. Reliance on the CT report alone underestimates the presence of incisional hernia. Referring physicians should not use CT as a screening modality for detection of hernias. Referral to a surgeon for evaluation before imaging may provide more accurate diagnosis and potentially decrease the cost of caring for this population.

Magnetic Resonance Imaging in the Diagnosis of Glomus Tumours of the Hand

2005 ◽  
Vol 30 (5) ◽  
pp. 535-540 ◽  
Author(s):  
M. M. AL-QATTAN ◽  
A. AL-NAMLA ◽  
A. AL-THUNAYAN ◽  
F. AL-SUBHI ◽  
A. F. EL-SHAYEB
Keyword(s):  
Predictive Value ◽  
Final Diagnosis ◽  
Senior Author ◽  
Glomus Tumour ◽  
Resonance Imaging ◽  
Predictive Values ◽  
Final Histological Diagnosis ◽  
Sensitivity Specificity ◽  
The Cost ◽  
Negative Imaging

This paper studies the sensitivity, specificity and predictive values of MRI in the diagnosis of glomus tumours of the hand and investigates the final diagnosis and outcome in cases with false positive or negative imaging tests. A total of 42 cases with the clinical diagnosis of a glomus tumour were included in the study. All patients underwent MRI and the results of MRI were correlated with the final histological diagnosis of the excised lesion. MRI had a sensitivity of 90%, a specificity of 50%, a positive predictive value of 97% and a negative predictive value of 20%. The four cases in which the MRI was negative all proved histologically to be glomus tumours. All four tumours were small (2–3 mm in diameter) and the lack of delineation of the lesions by MRI was attributed to their small size. Despite negative MRIs, surgical exploration identified the glomus tumours. Based on the results of the current study and the cost of MRI, the senior author has stopped ordering pre-operative MRIs in patients clinically diagnosed with a glomus tumour.

scholarly journals Improvement of the Osmotic Fragility (OF) Test in α Thalassemia 1 Screening for HIV-1 Infected Patients by The New Cutoff Values of MCV and MCH

2018 ◽  
Author(s):  
Sarayot Rareongjai ◽  
Sitthichai Panyasai ◽  
Santipap Sooncharoen ◽  
Soraya Mol-ar ◽  
Orathai Pongtussanahem
Keyword(s):  
Predictive Value ◽  
Osmotic Fragility ◽  
Mean Corpuscular Hemoglobin ◽  
Screening Process ◽  
Cutoff Values ◽  
Screening Efficiency ◽  
Sensitivity Specificity ◽  
The Cost ◽  
Hiv 1 ◽  
Thalassemia Screening

Objective: To evaluate the efficiencies of the standard α thalassemia screening regimen in human immunodeficiency virus (HIV) infected patients and improve the efficiencies of this screening regimen using new cutoff values.Material and Methods: A screening process using the osmotic fragility (OF) test, the old cutoff values of mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) at <80 fL and <22 pg, and the new cutoff values at <87 fL and <29 pg was performed in 300 HIV infected patients. After which, a genetic study was performed to detect common α thalassemia 1 genes deletions composed of Southeast Asian and THAI deletions and also for hemoglobin constant spring and hemoglobin Pakse mutations for α thalassemia 2 carriers. Screening efficiency was estimated by sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).Results: Sensitivity, specificity, PPV, and NPV of the original regimen for thalassemia screening in HIV infected patients were at 50.0%, 95.0%, 39.0% and 96.8%, respectively, demonstrating a high false positivity in HIV-1 infected populations. Therefore, new cutoff values for MCV and MCH were proposed at <87 fL and <29 pg, due to the highest value found in α thalassemia 1 carriers with HIV-1 infection. These new cutoff values showed higher sensitivity, specificity, PPV, and NPV at 100.0 92.6%, 46.2%, and 100.0%, respectively, and thus enhanced thalassemia screening efficiency in HIV-1 infected patients.Conclusion: Incorporation of the OF test and the new cutoff values for MCV and MCH improve the efficiencies of α thalassemia 1 screening in HIV-1 infected patients. This helps reduce the cost of confirming positive test results in α thalassemia screening.

scholarly journals Clinical diagnosis of COVID-19: a prompt, feasible, and sensitive diagnostic tool for COVID-19 based on a 1,757-patient cohort (The AndroCoV Clinical Scoring for COVID-19 diagnosis).

2020 ◽  
Author(s):  
Flavio A. Cadegiani ◽  
John McCoy ◽  
Carlos Gustavo Wambier ◽  
Andy Goren
Keyword(s):  
Clinical Diagnosis ◽  
Diagnostic Tool ◽  
Predictive Value ◽  
Large Population ◽  
Population Sample ◽  
Positive Likelihood Ratio ◽  
Household Contacts ◽  
Clinical Scoring ◽  
Sensitivity Specificity ◽  
The Cost

Abstract Importance: In the COVID-19 pandemic, a limiting barrier for more successful approaches to COVID-19 is the lack of appropriate timing for its diagnosis, during the viral replication stage, when antiviral approaches could demonstrate efficacy, precluding progression to severe stages. Three major reasons that hamper the diagnosis earlier in the disease are the unspecific and mild symptoms in the first stage, the cost- and time-limitations of the rtPCR-SARS-CoV-2, and the insufficient sensitivity of this test as desired for screening purposes during the pandemic. More sensitive and earlier methods of COVID-19 detection should be considered as key for breakthrough changes in the disease course and response to specific therapeutic strategies. Our objective was to propose a clinical scoring for the diagnosis of COVID-19 (The AndroCoV Clinical Scoring for COVID-19 Diagnosis) that has been validated in a large population sample, aiming to encourage the management of patients with high pre-clinical likelihood of presenting COVID-19, at least during the pandemics, independent of a rtPCR-SARS-COV-2 test. Materials and methods: This is a compounded retrospective and prospective analysis of clinical data prospectively collected from the Pre-AndroCoV and AndroCov Trials that resulted in a clinical scoring for COVID-19 diagnosis based on likelihood of presenting COVID-19 according to the number of symptoms, presence of anosmia, and known positive household contact, in a variety of combinations of scoring criteria, aiming to the detect scorings that provided the highest pre-test probability and accuracy. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and accuracy were calculated for subjects screened in two different periods and altogether, for females, males, and both, in a total of nine different scenarios, for combinations between one, two, or three or more symptoms, or presence of anosmia in subjects without known positive household contacts, and no symptoms, one, two, or three or more symptoms, or presence of anosmia or ageusia in subjects with known positive household contacts. Results: 1,757 patients were screened for COVID-19. Among the multiple combinations, requiring two or more symptoms with or without anosmia or ageusia for subjects without known contact and one or more symptoms with or without anosmia or ageusia with known positive contacts presented the highest accuracy (80.4%), and higher pretest probability and accuracy than virtually all rtPCR-SARS-CoV-2 commercially available kit tests. Conclusion: The AndroCoV Clinical Scoring for COVID-19 Diagnosis was demonstrated to be a feasible, quick, inexpensive and sensitive diagnostic tool for clinical diagnosis of COVID-19. A clinical diagnosis of COVID-19 should avoid delays and missed diagnosis, and reduce costs, and should therefore be recommended as a first-line option for COVID-19 diagnosis for public health policies, at least while SARS-CoV-2 is the prevailing circulating virus.

scholarly journals Temporal Intermittent Rhythmic Delta Activity (TIRDA) in the Diagnosis of Complex Partial Epilepsy: Sensitivity, Specificity and Predictive Value

1989 ◽  
Vol 16 (4) ◽  
pp. 398-401 ◽  
Author(s):  
Jean Reiher ◽  
Michel Beaudry ◽  
Charles P. Leduc
Keyword(s):  
Predictive Value ◽  
High Specificity ◽  
Partial Epilepsy ◽  
Sharp Waves ◽  
Complex Partial Epilepsy ◽  
Delta Activity ◽  
Rhythmic Delta Activity ◽  
Sensitivity Specificity ◽  
The Cost ◽  
Light Sleep

ABSTRACT:Temporal interictal rhythmic delta activity or TIRDA was found in 45 of the 127 recordings of patients with complex partial epilepsy (CPE) referred for both awake and sleep EEC TIRDA was more abundant during drowsiness and light sleep; it occurred more characteristically as trains of 50-100 µv sinusoidal or saw-toothed l-4Hz activity, recorded predominantly from anterior temporal regions. When occurring bilaterally and independently, TIRDA varied from side to side. TIRDA is often found in association with anterior temporal spikes or sharp waves (TS) particularly during sleep, as observed in 43 out of 45 EEGs. TIRDA can nevertheless occur as an isolated abnormality, as noted in two sleep and 12 awake study recordings. Because of its high specificity and positive predictive value over a large range of prevalence, TIRDA should be singled out as an accurate interictal indicator of CPE. In patients with isolated TIRDA, the cost of prolonged EEG recording during sleep for the purpose of activating TS has to be weighed against the yield of eventually confirming the obvious.

scholarly journals Use of Quantitative Ultrasound Scans of the Calcaneus to Diagnose Osteoporosis in Patients with Rheumatoid Arthritis

2007 ◽  
Vol 97 (2) ◽  
pp. 108-114 ◽  
Author(s):  
Jacqueline R. Cryer ◽  
Simon J. Otter ◽  
Catherine J. Bowen
Keyword(s):  
Rheumatoid Arthritis ◽  
Quantitative Ultrasound ◽  
Predictive Value ◽  
Disease Process ◽  
Predictive Values ◽  
Diagnosis Of Osteoporosis ◽  
Accessibility Issues ◽  
Sensitivity Specificity ◽  
The Cost ◽  
Future Work

Background: Patients with rheumatoid arthritis are recognized as being at risk for osteoporosis as a result of the disease process as well as the medication used to treat it. This study was conducted to consider the use of calcaneal scanning with quantitative ultrasound—contact ultrasound bone analysis (CUBA)—to diagnose osteoporosis in patients with rheumatoid arthritis.Methods: Forty-six patients (11 men and 35 women) with established rheumatoid arthritis underwent dual-energy x-ray absorptiometry (DEXA) of the nondominant wrist and CUBA of the nondominant heel. Sensitivity, specificity, and positive and negative predictive values were used to determine the correlation between osteoporosis as diagnosed by the CUBA heel scan compared with the DEXA wrist scan given that DEXA is widely seen as the gold standard for the diagnosis of osteoporosis.Results: The CUBA heel scan revealed a sensitivity of 90% and a specificity of 44% for a diagnosis of osteoporosis compared with DEXA. The positive predictive value of the CUBA scan was 31%, and the negative predictive value was 94%. Therefore, if normal bone density is found using CUBA, there is 94% certainty this is correct. However, if osteoporosis is diagnosed using CUBA, there is only 31% certainty this is correct. In such instances a secondary scan using a different method (eg, DEXA) would be required. Future work should consider the effect of minor alterations to the equipment or scanning protocol, because this may improve diagnosis.Conclusions: The CUBA unit could be used as a primary screening device. Given the cost and accessibility issues associated with DEXA, quantitative ultrasound may have a role in screening for osteoporosis in the primary-care setting to determine the most appropriate routes of referral for patients requiring further investigations. (J Am Podiatr Med Assoc 97(2): 108–114, 2007)

Noninvasive Evaluation of Coronary Artery Bypass Grafts with 16-Slice Multidetector Computed Tomography

2012 ◽  
Vol 15 (1) ◽  
pp. 12 ◽  
Author(s):  
Levent Sahiner ◽  
Ali Oto ◽  
Kudret Aytemir ◽  
Tuncay Hazirolan ◽  
Musturay Karcaaltincaba ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Multidetector Computed Tomography ◽  
Coronary Artery Bypass ◽  
Predictive Value ◽  
Artery Bypass ◽  
Time Interval ◽  
Mdct Angiography ◽  
Sensitivity Specificity

<p><b>Background:</b> The aim of this study was to investigate the diagnostic accuracy of 16-slice multislice, multidetector computed tomography (MDCT) angiography for the evaluation of grafts in patients with coronary artery bypass grafting (CABG).</p><p><b>Methods:</b> Fifty-eight consecutive patients with CABG who underwent both MDCT and conventional invasive coronary angiography were included. The median time interval between the 2 procedures was 10 days (range, 1-32 days). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT for the detection of occluded grafts were calculated. The accuracy of MDCT angiography for detecting significant stenoses in patent grafts and the evaluability of proximal and distal anastomoses were also investigated.</p><p><b>Results:</b> Optimal diagnostic images could not be obtained for only 3 (2%) of 153 grafts. Evaluation of the remaining 150 grafts revealed values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the MDCT angiography procedure for the diagnosis of occluded grafts of 87%, 97%, 94%, 93%, and 92%, respectively. All of the proximal anastomoses were optimally visualized. In 4 (8%) of 50 patent arterial grafts, however, the distal anastomotic region could not be evaluated because of motion and surgical-clip artifacts. The accuracy of MDCT angiography for the detection of significant stenotic lesions was relatively low (the sensitivity, specificity, PPV, and NPV were 67%, 98%, 50%, and 99%, respectively). The number of significant lesions was insufficient to reach a reliable conclusion, however.</p><p><b>Conclusion:</b> Our study showed that MDCT angiography with 16-slice systems has acceptable diagnostic performance for the evaluation of coronary artery bypass graft patency.</p>

Accuracy of Rotator Cuff Tears and Tendinosis Diagnoses on Shoulder Ultrasound Performed by a Short-experienced Operator

2018 ◽  
Vol 1 ◽  
pp. 9
Author(s):  
Harshad Arvind Vanjare ◽  
Jyoti Panwar
Keyword(s):  
Rotator Cuff ◽  
Negative Predictive Value ◽  
Rotator Cuff Tear ◽  
Predictive Value ◽  
Rotator Cuff Tears ◽  
Mri Findings ◽  
Cuff Tear ◽  
Experienced Operator ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

Objective The objective of the study was to assess the accuracy of ultrasound examination for the diagnosis of rotator cuff tear and tendinosis performed by a short experienced operator, compared to magnetic resonance imaging (MRI) results. Method A total of 70 subjects suspected to have rotator cuff tear or tendinosis and planned for shoulder MRI were included in the study. Shoulder ultrasound was performed either before or after the MRI scan on the same day. Ultrasound operator had a short experience in performing an ultrasound of the shoulder. Ultrasound findings were correlated to MRI findings. Results Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of tendinosis were 58%, 84%, 63%, 80%, and 75%, respectively, and it was 68%, 91%, 73%, 88%, and 85%, respectively, for the diagnosis of rotator cuff tear. Conclusions Sensitivity for diagnosing rotator cuff tear or tendinosis was moderate but had a higher negative predictive value. Thus, the ultrasound operator with a short experience in performing shoulder ultrasound had moderate sensitivity in diagnosing tendinosis or tears; however, could exclude them with confidence.

VALUE OF ST-SEGMENT ELEVATION IN LEAD AVR IN PREDICTING LEFT MAIN AND OR 3-VESSEL DISEASE IN PATIENTS WITH ACUTE CORONARY SYNDROMES

2017 ◽  
pp. 59-63
Author(s):  
Thanh Hung Dieu ◽  
Anh Vu Nguyen
Keyword(s):  
Predictive Value ◽  
Acute Coronary Syndromes ◽  
Independent Predictor ◽  
Left Main ◽  
St Segment Elevation ◽  
Vessel Disease ◽  
St Segment ◽  
Coronary Syndromes ◽  
Lead Avr ◽  
Sensitivity Specificity

Objects: We assessed the ability of ST-segment elevation in lead aVR to predict left main and/or 3-vessel disease (LM/3VD) in patients with acute coronary syndromes (ACS). Meterial and Method: 410 patients with ACS, who underwent coronary angiography, were evaluated. Results: 131 (31.9%) patients have been LM/3VD. ST segment elevation > 0.05 mV in leads aVR have been an independent predictor LM/3VD with sensitivity, specificity, positive predictive value PPV) and negative predictive value (NPV) 74.0%, 78.1%, 61.4% and 86.5%, respectively (p<0.001). ST segment elevation > 0.05 mV in leads aVR with ST segment depression in leads V4-V6 have related LM/3VD with sensitivity, specificity, PPV and NPV 44.3%, 92.8%, 74.4% and 75.2%, respectively (p<0.001). ST segment elevation > 0.1 mV in leads aVR have related LM/3VD with sensitivity, specificity, PPV and NPV 51.9%, 87.1%, 65.1% and 79.4%, respectively (p<0.001). Conclusions: ST segment elevation > 0.05 mV in leads aVR have been an independent predictor LM/3VD in patients with ACS. Key words: Acute coronary syndromes, ST-segment elevation, aVR

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