scholarly journals Diagnostic Performance of Electronic Syndromic Surveillance Systems in Acute Care

2013 ◽  
Vol 04 (02) ◽  
pp. 212-224 ◽  
Author(s):  
M. Kashiouris ◽  
J.C. O’Horo ◽  
B.W. Pickering ◽  
V. Herasevich
Keyword(s):  
Acute Care ◽  
Syndromic Surveillance ◽  
Diagnostic Performance ◽  
Clinical Decision Making ◽  
Wide Spectrum ◽  
Clinical Decision ◽  
Significant Heterogeneity ◽  
Surveillance Systems ◽  
Predictive Values ◽  
Decision Points

SummaryContext: Healthcare Electronic Syndromic Surveillance (ESS) is the systematic collection, analysis and interpretation of ongoing clinical data with subsequent dissemination of results, which aid clinical decision-making.Objective: To evaluate, classify and analyze the diagnostic performance, strengths and limitations of existing acute care ESS systems.Data Sources: All available to us studies in Ovid MEDLINE, Ovid EMBASE, CINAHL and Scopus databases, from as early as January 1972 through the first week of September 2012.Study Selection: Prospective and retrospective trials, examining the diagnostic performance of inpatient ESS and providing objective diagnostic data including sensitivity, specificity, positive and negative predictive values.Data Extraction: Two independent reviewers extracted diagnostic performance data on ESS systems, including clinical area, number of decision points, sensitivity and specificity. Positive and negative likelihood ratios were calculated for each healthcare ESS system. A likelihood matrix summarizing the various ESS systems performance was created.Results: The described search strategy yielded 1639 articles. Of these, 1497 were excluded on abstract information. After full text review, abstraction and arbitration with a third reviewer, 33 studies met inclusion criteria, reporting 102,611 ESS decision points. The yielded I2 was high (98.8%), precluding meta-analysis. Performance was variable, with sensitivities ranging from 21% –100% and specificities ranging from 5%-100%.Conclusions: There is significant heterogeneity in the diagnostic performance of the available ESS implements in acute care, stemming from the wide spectrum of different clinical entities and ESS systems. Based on the results, we introduce a conceptual framework using a likelihood ratio matrix for evaluation and meaningful application of future, frontline clinical decision support systems.Citation: Kashiouris M, O’Horo JC, Pickering BW, Herasevich V. Diagnostic performance of electronic syndromic surveillance systems in acute care – a systematic review. Appl Clin Inf 2013; 4: 212–224http://dx.doi.org/10.4338/ACI-2012-12-RA-0053

scholarly journals Evaluation and management of blunt injury abdomen based on focussed assessment with sonography in trauma

2020 ◽  
Vol 9 (1) ◽  
pp. 61
Author(s):  
Sameer Ahmed
Keyword(s):  
Computed Tomography ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Blunt Injury ◽  
Predictive Values ◽  
Bedside Test ◽  
Intraabdominal Injuries ◽  
Low Sensitivity

Background: The initial evaluation of patient with multiple trauma is a challenging task. FAST (focussed assessment with sonography in trauma) provides a viable alternative to computed tomography in blunt abdominal trauma patient. The aim of this study was to find the accuracy and utility of FAST in clinical decision making, as well as limitations.Methods: A total of 100 patients with blunt abdominal trauma who underwent FAST examination were included. Positive scan was defined as the presence of free intraperitoneal fluid. The sonographic scoring for operating room triage in trauma (SSORTT Score) was calculated using cumulative sum of ultrasound score, systolic blood pressure, and pulse rate. FAST findings were compared with computed tomography findings and in operated cases compared with surgical findings & clinical outcome.Results: We determined SSORTT score in all 100 cases. In our study, the sensitivity, specificity, positive and negative predictive values for FAST in identifying intraabdominal injuries were 93.9%, 94.2%, 87.5%, and 97.2%. In our study we found out that patients with a SSORTT score of 2 and above had a high likelihood of requiring a therapeutic laparotomy.Conclusions: In our study we found that FAST is a rapid, reproducible, portable and non-invasive bedside test, and can be performed at the same time as resuscitation. Ultrasound is limited mainly by its low sensitivity in directly demonstrating solid organs injuries.

scholarly journals Accounting for healthcare-seeking behaviours and testing practices in real-time influenza forecasts

2018 ◽  
Author(s):  
Robert Moss ◽  
Alexander E Zarebski ◽  
Sandra J Carlson ◽  
James M McCaw
Keyword(s):  
Real Time ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surveillance Data ◽  
Surveillance Systems ◽  
Healthcare Seeking ◽  
Public Health Decision ◽  
Predictive Skill ◽  
Health Decision ◽  
Substantial Change

AbstractFor diseases such as influenza, where the majority of infected persons experience mild (if any) symptoms, surveillance systems are sensitive to changes in healthcare-seeking and clinical decision-making behaviours. This presents a challenge when trying to interpret surveillance data in near-real-time (e.g., in order to provide public health decision-support). Australia experienced a particularly large and severe influenza season in 2017, perhaps in part due to (a) mild cases being more likely to seek healthcare; and (b) clinicians being more likely to collect specimens for RT-PCR influenza tests. In this study we used weekly Flutracking surveillance data to estimate the probability that a person with influenza-like illness (ILI) would seek healthcare and have a specimen collected. We then used this estimated probability to calibrate near-real-time seasonal influenza forecasts at each week of the 2017 season, to see whether predictive skill could be improved. While the number of self-reported influenza tests in the weekly surveys are typically very low, we were able to detect a substantial change in healthcare seeking behaviour and clinician testing behaviour prior to the high epidemic peak. Adjusting for these changes in behaviour in the forecasting framework improved predictive skill. Our analysis demonstrates a unique value of community-level surveillance systems, such as Flutracking, when interpreting traditional surveillance data.

scholarly journals Acute care nurses' perceptions of barriers to using research information in clinical decision-making

2002 ◽  
Vol 39 (1) ◽  
pp. 46-60 ◽  
Author(s):  
Dorothy McCaughan ◽  
Carl Thompson ◽  
Nicky Cullum ◽  
Trevor A. Sheldon ◽  
David R. Thompson
Keyword(s):  
Decision Making ◽  
Acute Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Research Information ◽  
Acute Care Nurses ◽  
Nurses Perceptions

scholarly journals Evaluation of a faecal calprotectin care pathway for use in primary care

2016 ◽  
Vol 17 (05) ◽  
pp. 428-436 ◽  
Author(s):  
James Turvill ◽  
Shaun O’Connell ◽  
Abigail Brooks ◽  
Karen Bradley-Wood ◽  
James Laing ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Decision Making ◽  
Diagnostic Yield ◽  
Care Pathway ◽  
Gastrointestinal Symptoms ◽  
Clinical Decision ◽  
Traffic Light ◽  
Faecal Calprotectin ◽  
Predictive Values ◽  
Light System

BackgroundNational Institute for Health and Care Excellence have recommended faecal calprotectin (FC) testing as an option in adults with lower gastrointestinal symptoms for whom specialist investigations are being considered, if cancer is not suspected and it is used to support a diagnosis of inflammatory bowel disease (IBD) or irritable bowel syndrome. York Hospital and Vale of York Clinical Commissioning Group have developed an evidence-based care pathway to support this recommendation for use in primary care. It incorporates a higher FC cut-off value, a ‘traffic light’ system for risk and a clinical management pathway.ObjectivesTo evaluate this care pathway.MethodsThe care pathway was introduced into five primary care practices for a period of six months and the clinical outcomes of patients were evaluated. Negative and positive predictive values (NPV and PPV) were calculated. GP feedback of the care pathway was obtained by means of a web-based survey. Comparator gastroenterology activity in a neighbouring trust was obtained.ResultsThe care pathway for FC in primary care had a 97% NPV and a 40% PPV. This was better than GP clinical judgement alone and doubled the PPV compared with the standard FC cut-off (<50 mcg/g), without affecting the NPV. In total, 89% of patients with IBD had an FC>250 mcg/g and were diagnosed by ‘straight to test’ colonoscopy within three weeks. The care pathway was considered helpful by GPs and delivered a higher diagnostic yield after secondary care referral (21%) than the conventional comparator pathway (5%).ConclusionsA care pathway for the use of FC that incorporates a higher cut-off value, a ‘traffic light’ system for risk and supports clinical decision making can be achieved safely and effectively. It maintains the balance between a high NPV and an acceptable PPV. A modified care pathway for the use of FC in primary care is proposed.

scholarly journals Prognostic Factors and a Nomogram Predicting Overall Survival in Patients with Limb Chondrosarcomas: A Population-Based Study

2021 ◽  
Vol 2021 ◽  
pp. 1-17
Author(s):  
Xinjie Wu ◽  
Yanlei Wang ◽  
Wei Sun ◽  
Mingsheng Tan
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Clinical Decision Making ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Training Group ◽  
Clinical Decision ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Predictive Values

Introduction. We aimed to develop and validate a nomogram for predicting the overall survival of patients with limb chondrosarcomas. Methods. The Surveillance, Epidemiology, and End Results (SEER) program database was used to identify patients diagnosed with chondrosarcomas, from which data was extracted from 18 registries in the United States between 1973 and 2016. A total of 813 patients were selected from the database. Univariate and multivariate analyses were performed using Cox proportional hazards regression models on the training group to identify independent prognostic factors and construct a nomogram to predict the 3- and 5-year survival probability of patients with limb chondrosarcomas. The predictive values were compared using concordance indexes ( C -indexes) and calibration plots. Results. All 813 patients were randomly divided into a training group ( n = 572 ) and a validation group ( n = 241 ). After univariate and multivariate Cox regression, a nomogram was constructed based on a new model containing the predictive variables of age, site, grade, tumor size, histology, stage, and use of surgery, radiotherapy, or chemotherapy. The prediction model provided excellent C -indexes (0.86 and 0.77 in the training and validation groups, respectively). The good discrimination and calibration of the nomograms were demonstrated for both the training and validation groups. Conclusions. The nomograms precisely and individually predict the overall survival of patients with limb chondrosarcomas and could assist personalized prognostic evaluation and individualized clinical decision-making.

scholarly journals Prospective validation of a molecular prognostication panel for clival chordoma

2019 ◽  
Vol 130 (5) ◽  
pp. 1528-1537 ◽  
Author(s):  
Georgios A. Zenonos ◽  
Juan C. Fernandez-Miranda ◽  
Debraj Mukherjee ◽  
Yue-Fang Chang ◽  
Klea Panayidou ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Clinical Decision Making ◽  
Cox Model ◽  
Wide Spectrum ◽  
Progression Free Survival ◽  
Clinical Decision ◽  
Homozygous Deletion ◽  
Ki 67 ◽  
Free Survival ◽  
Clival Chordoma

OBJECTIVEThere are currently no reliable means to predict the wide variability in behavior of clival chordoma so as to guide clinical decision-making and patient education. Furthermore, there is no method of predicting a tumor’s response to radiation therapy.METHODSA molecular prognostication panel, consisting of fluorescence in situ hybridization (FISH) of the chromosomal loci 1p36 and 9p21, as well as immunohistochemistry for Ki-67, was prospectively evaluated in 105 clival chordoma samples from November 2007 to April 2016. The results were correlated with overall progression-free survival after surgery (PFSS), as well as progression-free survival after radiotherapy (PFSR).RESULTSAlthough Ki-67 and the percentages of tumor cells with 1q25 hyperploidy, 1p36 deletions, and homozygous 9p21 deletions were all found to be predictive of PFSS and PFSR in univariate analyses, only 1p36 deletions and homozygous 9p21 deletions were shown to be independently predictive in a multivariate analysis. Using a prognostication calculator formulated by a separate multivariate Cox model, two 1p36 deletion strata (0%–15% and > 15% deleted tumor cells) and three 9p21 homozygous deletion strata (0%–3%, 4%–24%, and ≥ 25% deleted tumor cells) accounted for a range of cumulative hazard ratios of 1 to 56.1 for PFSS and 1 to 75.6 for PFSR.CONCLUSIONSHomozygous 9p21 deletions and 1p36 deletions are independent prognostic factors in clival chordoma and can account for a wide spectrum of overall PFSS and PFSR. This panel can be used to guide management after resection of clival chordomas.

scholarly journals Accounting for Healthcare-Seeking Behaviours and Testing Practices in Real-Time Influenza Forecasts

2019 ◽  
Vol 4 (1) ◽  
pp. 12 ◽  
Author(s):  
Robert Moss ◽  
Alexander Zarebski ◽  
Sandra Carlson ◽  
James McCaw
Keyword(s):  
Real Time ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surveillance Data ◽  
Community Level ◽  
Surveillance Systems ◽  
Healthcare Seeking ◽  
Public Health Decision ◽  
Predictive Skill ◽  
Health Decision

For diseases such as influenza, where the majority of infected persons experience mild (if any) symptoms, surveillance systems are sensitive to changes in healthcare-seeking and clinical decision-making behaviours. This presents a challenge when trying to interpret surveillance data in near-real-time (e.g., to provide public health decision-support). Australia experienced a particularly large and severe influenza season in 2017, perhaps in part due to: (a) mild cases being more likely to seek healthcare; and (b) clinicians being more likely to collect specimens for reverse transcription polymerase chain reaction (RT-PCR) influenza tests. In this study, we used weekly Flutracking surveillance data to estimate the probability that a person with influenza-like illness (ILI) would seek healthcare and have a specimen collected. We then used this estimated probability to calibrate near-real-time seasonal influenza forecasts at each week of the 2017 season, to see whether predictive skill could be improved. While the number of self-reported influenza tests in the weekly surveys are typically very low, we were able to detect a substantial change in healthcare seeking behaviour and clinician testing behaviour prior to the high epidemic peak. Adjusting for these changes in behaviour in the forecasting framework improved predictive skill. Our analysis demonstrates a unique value of community-level surveillance systems, such as Flutracking, when interpreting traditional surveillance data. These methods are also applicable beyond the Australian context, as similar community-level surveillance systems operate in other countries.

Diagnostic performance of the noninvasive prenatal FetoGnost RhD assay for the prediction of the fetal RhD blood group status

2021 ◽  
Author(s):  
Tobias J. Legler ◽  
Sandra Lührig ◽  
Irina Korschineck ◽  
Dieter Schwartz
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Performance ◽  
Clinical Decision Making ◽  
False Negative ◽  
Clinical Decision ◽  
Multiple Pregnancies ◽  
Group Status ◽  
Test Kit ◽  
Existing Data

Abstract Purpose: To evaluate the diagnostic accuracy of a commercially available test kit for noninvasive prenatal determination of the fetal RhD status (NIPT-RhD) with a focus on early gestation and multiple pregnancies. Methods: The FetoGnost RhD assay (Ingenetix, Vienna, Austria) is routinely applied for clinical decision making either in woman with anti-D alloimmunization or in order to target the application of routine antenatal anti-D prophylaxis (RAADP) to women with a RhD positive fetus. Based on existing data in the laboratory information system the newborn’s serological RhD status was compared with NIPT RhD results. Results: Since 2009 NIPT RhD was performed in 2,968 pregnant women between week 5+6 and 40+0 of gestation (median 12+6) and conclusive results were obtained in 2,888 (97.30%) cases. Diagnostic accuracy was calculated from those 2244 (77.70%) cases with the newborn’s serological RhD status reported. The sensitivity of the FetoGnost RhD assay was 99.93% (95% CI 99.61% - 99.99%) and the specificity was 99.61% (95% CI 98.86% - 99.87%). No false positive or false negative NIPT RhD result was observed in 203 multiple pregnancies. Conclusion: NIPT RhD results are reliable when obtained with FetoGnost RhD assay. Targeted routine anti-D-prophylaxis can start as early as 11+0 weeks of gestation in singleton and multiple pregnancies.

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