scholarly journals Sensitivity and Specificity of Community Fecal Immunotesting Screening for Colorectal Carcinoma in a High-Risk Canadian Population

2015 ◽  
Vol 139 (11) ◽  
pp. 1441-1445 ◽  
Author(s):  
Amber L. Crouse ◽  
Lawrence De Koning ◽  
S. M. Hossein Sadrzadeh ◽  
Christopher Naugler
Keyword(s):  
High Risk ◽  
Colorectal Carcinoma ◽  
Confidence Interval ◽  
Primary Care Physicians ◽  
Screening Method ◽  
Older Individuals ◽  
Predictive Values ◽  
Fecal Immunochemical Testing ◽  
Colonic Adenomas ◽  
Operational Test

Context Community-based programs are a common way of promoting colorectal cancer screening by primary care physicians. Fecal immunochemical testing (FIT) is a screening method commonly used in such programs. Fecal immunochemical testing has advantages to the patient as well as to clinical laboratories. Objective To assess the operational test characteristics of a FIT pilot program in Calgary, Alberta, Canada, between April 2011 and May 2012. Design Four hundred fifty-seven high-risk patients undergoing both FIT and colonoscopy were included. Areas under the curve and positive predictive values were derived for FIT values and biopsy-proven neoplasia. Subgroup analysis was also performed on men and women and for ages older and younger than the mean age of 62 years. Results For colorectal carcinoma and colonic adenomas the areas under the curve were 0.79 (95% confidence interval 0.71–0.87) and 0.60 (95% confidence interval 0.54–0.65), respectively. The positive predictive value of a positive FIT result for any neoplasia was 53%. The overall performance of the test for all neoplasia was better for men and better for older individuals. Conclusions The performance of FIT in this clinical setting was very good for detecting carcinoma, but marginal for detection of colonic adenomas.

scholarly journals Development of a prediction model to aid primary care physicians in early identification of women at high risk of developing endometriosis: cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e030346
Author(s):  
Nina Julie Verket ◽  
Ragnhild Sørum Falk ◽  
Erik Qvigstad ◽  
Tom Gunnar Tanbo ◽  
Leiv Sandvik
Keyword(s):  
Primary Care ◽  
Family History ◽  
High Risk ◽  
Prediction Model ◽  
Early Identification ◽  
Primary Care Physicians ◽  
Lasso Regression ◽  
Cross Sectional ◽  
Predictive Values ◽  
History Of

ObjectivesTo identify predictors of disease among a few factors commonly associated with endometriosis and if successful, to combine these to develop a prediction model to aid primary care physicians in early identification of women at high risk of developing endometriosis.DesignCross-sectional anonymous postal questionnaire study.SettingWomen aged 18–45 years recruited from the Norwegian Endometriosis Association and a random sample of women residing in Oslo, Norway.Participants157 women with and 156 women without endometriosis.Main outcome measuresLogistic and least absolute shrinkage and selection operator (LASSO) regression analyses were performed with endometriosis as dependent variable. Predictors were identified and combined to develop a prediction model. The predictive ability of the model was evaluated by calculating the area under the receiver operating characteristic curve (AUC) and positive predictive values (PPVs) and negative predictive values (NPVs). To take into account the likelihood of skewed representativeness of the patient sample towards high symptom burden, we considered the hypothetical prevalences of endometriosis in the general population 0.1%, 0.5%, 1% and 2%.ResultsThe predictors absenteeism from school due to dysmenorrhea and family history of endometriosis demonstrated the strongest association with disease. The model based on logistic regression (AUC 0.83) included these two predictors only, while the model based on LASSO regression (AUC 0.85) included two more: severe dysmenorrhea in adolescence and use of painkillers due to dysmenorrhea in adolescence. For the prevalences 0.1%, 0.5%, 1% and 2%, both models ascertained endometriosis with PPV equal to 2.0%, 9.4%, 17.2% and 29.6%, respectively. NPV was at least 98% for all values considered.ConclusionsExternal validation is needed before model implementation. Meanwhile, endometriosis should be considered a differential diagnosis in women with frequent absenteeism from school or work due to painful menstruations and positive family history of endometriosis.

scholarly journals Joint predictive value of cTnI and NT-proBNP on mortality in patients with coronavirus disease 2019: A retrospective research in Wuhan, China

2021 ◽  
Vol 9 (3) ◽  
pp. 177-184
Author(s):  
Haoyu Weng ◽  
Fan Yang ◽  
Long Zhang ◽  
Han Jin ◽  
Shengcong Liu ◽  
...  
Keyword(s):  
High Risk ◽  
Confidence Interval ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cox Regression ◽  
Cardiac Injury ◽  
Predictive Values ◽  
Course Of Disease ◽  
Risk Of Death ◽  
The World

Abstract Background and Objectives The pandemic of coronavirus disease 2019 (COVID-19) remains to be the biggest public threat all over the world. Because of the rapid deterioration in some patients, markers that could predict poor clinical outcomes are urgently required. This study was to evaluate the predictive values of cardiac injury parameters, including cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, on mortality in COVID-19 patients. Methods COVID-19 patients in Zhongfaxincheng branch of Tongji Hospital (Wuhan, China) from February 8–28, 2020, were enrolled in this study. We followed up the patients for 30 days after admission. Results A total of 134 patients were included in the study. Multivariate Cox regression showed that 1) patients with elevated cTnI levels had a higher risk of death (hazard ratio [HR] 7.33, 95% confidence interval [CI] 2.56–21.00) than patients with normal cTnI levels; 2) patients with elevated NT-proBNP levels had a higher risk of death (HR 27.88, 95% CI 3.55–218.78) than patients with normal NT-proBNP levels; 3) patients with both elevated cTnI and NT-proBNP levels had a significantly higher risk of death (HR 53.87, 95% CI 6.31–459.91, P < 0.001) compared to patients without elevated cTnI or NT-proBNP levels; 4) the progressions of cTnI and NT-proBNP levels were also correlated with death (HR 12.70, 95% CI 3.94–40.88, P < 0.001 and HR 51.09, 95% CI 5.82–448.26, P < 0.001). Conclusions In COVID-19 patients, cTnI and NT-proBNP levels could be monitored to identify patients at a high risk of death in their later course of disease.

Do Questions About Lead Exposure Predict Elevated Lead Levels?

PEDIATRICS ◽  
1994 ◽  
Vol 93 (2) ◽  
pp. 192-194 ◽  
Author(s):  
David M. Tejeda ◽  
Deborah D. Wyatt ◽  
Barry R. Rostek ◽  
William B. Solomon
Keyword(s):  
High Risk ◽  
Disease Control ◽  
Lead Poisoning ◽  
Screening Method ◽  
Predictive Values ◽  
Pediatric Clinic ◽  
Control And Prevention ◽  
Lead Levels ◽  
Centers For Disease Control ◽  
Definition Of

Objective. To assess the usefulness of the lead poisoning questionnaire developed by the Centers for Disease Control and Prevention as a screening tool for elevated lead levels. Methods. This descriptive study used a five-question questionnaire at our hospital-based general pediatric clinic and in two local private practices. We obtained venous lead levels from 485 children aged 9 months to 6 years who were brought for health supervision visits. The questionnaire was completed by a primary caretaker of 330 patients (68%). Contingency tables were used to compare lead levels with the responses on the questionnaire. Results. Lead levels of ≥10 µg/dL were found in 23 (7%) of 330 who completed the questionnaire. Caretakers of children with elevated lead levels were more likely to answer yes to questions about chipping paint and home remodeling than those whose children had levels &lt;10 (P = .0001). These questions had sensitivities for detecting elevated lead levels of 70% and 74% with negative predictive values of 97% and 98%, respectively. Questions about known contacts with lead poisoning and job or industrial exposure to lead each had sensitivities of &lt;10%. The Centers for Disease Control and Prevention's definition of high risk for lead poisoning (one or more positive responses) was nearly 90% sensitive for detecting elevated lead levels with a negative predictive value of 99%. Conclusion. This risk assessment questionnaire is an effective screening method for elevated lead levels in our population. Questions about the home environment were more sensitive indicators of elevated lead levels than other standard high-risk questions.

Is Colour Doppler Ultrasound a Sensitive Screening Method in Diagnosing Deep Vein Thrombosis after Hip Surgery ?

1996 ◽  
Vol 75 (02) ◽  
pp. 242-245 ◽  
Author(s):  
Marie Magnusson ◽  
Bengt I Eriksson ◽  
Peter Kãlebo ◽  
Ramon Sivertsson
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Doppler Ultrasound ◽  
Predictive Value ◽  
Screening Method ◽  
Colour Doppler ◽  
Vein Thrombosis ◽  
Colour Doppler Ultrasound ◽  
Asymptomatic Patients ◽  
Deep Vein

SummaryPatients undergoing orthopedic surgery are at high risk of developing deep vein thrombosis. One hundred and thirty-eight consecutive patients undergoing total hip replacement or hip fracture surgery were included in this study. They were surveilled with colour Doppler ultrasound (CDU) and bilateral ascending contrast phlebography. The prevalence of proximal and distal DVT in this study was 5.8% and 20.3% respectively.CDU has a satisfactory sensitivity in patients with symptomatic deep vein thrombosis, especially in the proximal region. These results could not be confirmed in the present study of asymptomatic patients. The sensitivity was 62.5% (95% confidence interval: C.I. 24-91%) and the specificity 99.6% (C.I. 98-100%) for proximal DVT; 53.6% (C.I. 34-73%) and 98% (C.I. 96-99%) respectively for distal thrombi. The overall sensitivity was 58.1% (C.I. 39-75%) and the specificity 98% (C.I. 96-99%). The positive predictive value was 83.3% (C.I. 36-99%) and 75% (C.I. 51-91%) for proximal and distal DVT respectively. The negative predictive value was 98.9% (C.I. 98-100%) and 94.9% (C.I. 92-98%) for proximal and distal DVT respectively. The results of this study showed that even with a highly specialised and experienced investigator the sensitivity of CDU was too low to make it suitable for screening purposes in a high risk surgical population.

scholarly journals Healthcare Provider Perspectives on Bipolar I Disorder Screening and the Rapid Mood Screener (RMS), a Pragmatic, New Tool

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 181-183
Author(s):  
Michael E. Thase ◽  
Stephen M. Stahl ◽  
Roger S. McIntyre ◽  
Tina Matthews-Hayes ◽  
Mehul Patel ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Screening Tool ◽  
Positive Impact ◽  
Screening Tools ◽  
Predictive Values ◽  
Bipolar I Disorder ◽  
Provider Perspectives ◽  
Patient Reported

AbstractIntroductionAlthough mania is the hallmark symptom of bipolar I disorder (BD-I), most patients initially present for treatment with depressive symptoms. Misdiagnosis of BD-I as major depressive disorder (MDD) is common, potentially resulting in poor outcomes and inappropriate antidepressant monotherapy treatment. Screening patients with depressive symptoms is a practical strategy to help healthcare providers (HCPs) identify when additional assessment for BD-I is warranted. The new 6-item Rapid Mood Screener (RMS) is a pragmatic patient-reported BD-I screening tool that relies on easily understood terminology to screen for manic symptoms and other BD-I features in <2 minutes. The RMS was validated in an observational study in patients with clinically confirmed BD-I (n=67) or MDD (n=72). When 4 or more items were endorsed (“yes”), the sensitivity of the RMS for identifying patients with BP-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. To more thoroughly understand screening tool use among HCPs, a 10-minute survey was conducted.MethodsA nationwide sample of HCPs (N=200) was selected using multiple HCP panels; HCPs were asked to describe their opinions/current use of screening tools, assess the RMS, and evaluate the RMS versus the widely recognized Mood Disorder Questionnaire (MDQ). Results were reported by grouped specialties (primary care physicians, general nurse practitioners [NPs]/physician assistants [PAs], psychiatrists, and psychiatric NPs/PAs). Included HCPs were in practice <30 years, spent at least 75% of their time in clinical practice, saw at least 10 patients with depression per month, and diagnosed MDD or BD in at least 1 patient per month. Findings were reported using descriptive statistics; statistical significance was reported at the 95% confidence interval.ResultsAmong HCPs, 82% used a tool to screen for MDD, while 32% used a tool for BD. Screening tool attributes considered to be of the greatest value included sensitivity (68%), easy to answer questions (66%), specificity (65%), confidence in results (64%), and practicality (62%). Of HCPs familiar with screening tools, 70% thought the RMS was at least somewhat better than other screening tools. Most HCPs were aware of the MDQ (85%), but only 29% reported current use. Most HCPs (81%) preferred the RMS to the MDQ, and the RMS significantly outperformed the MDQ across valued attributes; 76% reported that they were likely to use the RMS to screen new patients with depressive symptoms. A total of 84% said the RMS would have a positive impact on their practice, with 46% saying they would screen more patients for bipolar disorder.DiscussionThe RMS was viewed positively by HCPs who participated in a brief survey. A large percentage of respondents preferred the RMS over the MDQ and indicated that they would use it in their practice. Collectively, responses indicated that the RMS is likely to have a positive impact on screening behavior.FundingAbbVie Inc.

scholarly journals Expanded noninvasive prenatal testing for fetal aneuploidy and copy number variations and parental willingness for invasive diagnosis in a cohort of 18,516 cases

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Yunsheng Ge ◽  
Jia Li ◽  
Jianlong Zhuang ◽  
Jian Zhang ◽  
Yanru Huang ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
High Risk ◽  
Pregnant Women ◽  
Copy Number ◽  
Prenatal Testing ◽  
Copy Number Variations ◽  
Trisomy 13 ◽  
Noninvasive Prenatal Testing ◽  
Predictive Values ◽  
Parental Willingness

Abstract Background Noninvasive prenatal testing (NIPT) has been wildly used to screen for common aneuplodies. In recent years, the test has been expanded to detect rare autosomal aneuploidies (RATs) and copy number variations (CNVs). This study was performed to investigate the performance of expanded noninvasive prenatal testing (expanded NIPT) in screening for common trisomies, sex chromosomal aneuploidies (SCAs), rare autosomal aneuploidies (RATs), and copy number variations (CNVs) and parental willingness for invasive prenatal diagnosis in a Chinese prenatal diagnosis center. Methods A total of 24,702 pregnant women were retrospectively analyzed at the Women and Children’s Hospital from January 2013 to April 2019, among which expanded NIPT had been successfully conducted in 24,702 pregnant women. The high-risk expanded NIPT results were validated by karyotype analysis and chromosomal microarray analysis. All the tested pregnant women were followed up for pregnancy outcomes. Results Of the 24,702 cases, successful follow-up was conducted in 98.77% (401/446) of cases with common trisomies and SCAs, 91.95% (80/87) of RAT and CNV cases, and 76.25% (18,429/24,169) of cases with low-risk screening results. The sensitivity of expanded NIPT was 100% (95% confidence interval[CI], 97.38–100%), 96.67%(95%CI, 82.78–99.92%), and 100%(95%CI, 66.37–100.00%), and the specificity was 99.92%(95%CI, 99.87–99.96%), 99.96%(95%CI, 99.91–99.98%), and 99.88% (95%CI, 99.82–99.93%) for the detection of trisomies 21, 18, and 13, respectively. Expanded NIPT detected 45,X, 47,XXX, 47,XXY, XYY syndrome, RATs, and CNVs with positive predictive values of 25.49%, 75%, 94.12%, 76.19%, 6.45%, and 50%, respectively. The women carrying fetuses with Trisomy 21/Trisomy 18/Trisomy 13 underwent invasive prenatal diagnosis and terminated their pregnancies at higher rates than those at high risk for SCAs, RATs, and CNVs. Conclusions Our study demonstrates that the expanded NIPT detects fetal trisomies 21, 18, and 13 with high sensitivity and specificity. The accuracy of detecting SCAs, RATs, and CNVs is still relatively poor and needs to be improved. With a high-risk expanded NIPT result, the women at high risk for common trisomies are more likely to undergo invasive prenatal diagnosis procedures and terminate their pregnancies than those with unusual chromosome abnormalities.

scholarly journals A diabetes risk score for Qatar utilizing a novel mathematical modeling approach to identify individuals at high risk for diabetes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Susanne F. Awad ◽  
Soha R. Dargham ◽  
Amine A. Toumi ◽  
Elsy M. Dumit ◽  
Katie G. El-Nahas ◽  
...  
Keyword(s):  
High Risk ◽  
Sensitivity And Specificity ◽  
Risk Score ◽  
Area Under The Curve ◽  
Diabetes Risk ◽  
Predictive Values ◽  
Predictive Variables ◽  
Comparable Performance ◽  
Representative Random Sample ◽  
Diabetes Risk Score

AbstractWe developed a diabetes risk score using a novel analytical approach and tested its diagnostic performance to detect individuals at high risk of diabetes, by applying it to the Qatari population. A representative random sample of 5,000 Qataris selected at different time points was simulated using a diabetes mathematical model. Logistic regression was used to derive the score using age, sex, obesity, smoking, and physical inactivity as predictive variables. Performance diagnostics, validity, and potential yields of a diabetes testing program were evaluated. In 2020, the area under the curve (AUC) was 0.79 and sensitivity and specificity were 79.0% and 66.8%, respectively. Positive and negative predictive values (PPV and NPV) were 36.1% and 93.0%, with 42.0% of Qataris being at high diabetes risk. In 2030, projected AUC was 0.78 and sensitivity and specificity were 77.5% and 65.8%. PPV and NPV were 36.8% and 92.0%, with 43.0% of Qataris being at high diabetes risk. In 2050, AUC was 0.76 and sensitivity and specificity were 74.4% and 64.5%. PPV and NPV were 40.4% and 88.7%, with 45.0% of Qataris being at high diabetes risk. This model-based score demonstrated comparable performance to a data-derived score. The derived self-complete risk score provides an effective tool for initial diabetes screening, and for targeted lifestyle counselling and prevention programs.

scholarly journals Multimodality Screening of High-Risk Women: A Prospective Cohort Study

2009 ◽  
Vol 27 (36) ◽  
pp. 6124-6128 ◽  
Author(s):  
Susan P. Weinstein ◽  
A. Russell Localio ◽  
Emily F. Conant ◽  
Mark Rosen ◽  
Kathleen M. Thomas ◽  
...  
Keyword(s):  
High Risk ◽  
Digital Mammography ◽  
Imaging Modality ◽  
Screening Method ◽  
High Risk Group ◽  
Breast Cancers ◽  
Screen Mammogram ◽  
Dense Breast Tissue ◽  
High Risk Women ◽  
Screening Population

Purpose Mammography has been established as the primary imaging screening method for breast cancer; however, the sensitivity of mammography is limited, especially in women with dense breast tissue. Given the limitations of mammography, interest has developed in alternative screening techniques. This interest has led to numerous studies reporting mammographically occult breast cancers detected on magnetic resonance imaging (MRI) or ultrasound. In addition, digital mammography was shown to be more sensitive than film mammography in selected populations. Our goal was to prospectively compare cancer detection of digital mammography (DM), whole-breast ultrasound (WBUS), and contrast-enhanced MRI in a high-risk screening population previously screened negative by film screen mammogram (FSM). Methods During a 2-year period, 609 asymptomatic high-risk women with nonactionable FSM examinations presented for a prospective multimodality screening consisting of DM, WBUS, and MRI. The FSM examinations were reinterpreted by study radiologists. Patients had benign or no suspicious findings on clinical examination. The cancer yield by modality was evaluated. Results Twenty cancers were diagnosed in 18 patients (nine ductal carcinomas in situ and 11 invasive breast cancers). The overall cancer yield on a per-patient basis was 3.0% (18 of 609 patients). The cancer yield by modality was 1.0% for FSM (six of 597 women), 1.2% for DM (seven of 569 women), 0.53% for WBUS (three of 567 women), and 2.1% for MRI (12 of 571 women). Of the 20 cancers detected, some were only detected on one imaging modality (FSM, n = 1; DM, n = 3; WBUS, n = 1; and MRI, n = 8). Conclusion The addition of MRI to mammography in the high-risk group has the greatest potential to detect additional mammographically occult cancers. The incremental cancer yield of WBUS and DM is much less.

Febrile Infants at Low Risk for Serious Bacterial Infection—An Appraisal of the Rochester Criteria and Implications for Management

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 390-396 ◽  
Author(s):  
Julie A. Jaskiewicz ◽  
Carol A. McCarthy ◽  
Amy C. Richardson ◽  
Kathleen C. White ◽  
Donna J. Fisher ◽  
...  
Keyword(s):  
Confidence Interval ◽  
High Power ◽  
Microscopic Examination ◽  
Bacterial Infections ◽  
Antimicrobial Agents ◽  
Low Risk ◽  
High Power Field ◽  
Urine Sediment ◽  
Predictive Values ◽  
Risk Criteria

Objective. Prospective studies were conducted to test the hypothesis that infants unlikely to have serious bacterial infections (SBI) can be accurately identified by low risk criteria. Methods. Febrile infants (rectal T ≥ 38°C) ≤60 days of age were considered at low risk for SBI if they met the following criteria: 1) appear well; 2) were previously healthy; 3) have no focal infection; 4) have WBC count 5.0-15.0 x 109 cells/L (5000-15 000/mm3), band form count≤ 1.5 x 109 cells/L (≤1500/mm3), ≤10 WBC per high power field on microscopic examination of spun urine sediment, and ≤5 WBC per high power field on microscopic examination of a stool smear (if diarrhea). The recommended evaluation included the culture of specimens of blood, cerebrospinal fluid, and urine for bacteria. Outcomes were determined. The negative predictive values of the low risk criteria for SBI and bacteremia were calculated. Results. Of 1057 eligible infants, 931 were well appearing, and, of these, 437 met the remaining low risk criteria. Five low risk infants had SBI including two infants with bacteremia. The negative predictive value of the low risk criteria was 98.9% (95% confidence interval, 97.2% to 99.6%) for SBI, and 99.5% (95% confidence interval, 98.2% to 99.9%) for bacteremia. Conclusions. These data confirm the ability of the low risk criteria to identify infants unlikely to have SBI. Infants who meet the low risk criteria can be carefully observed without administering antimicrobial agents.

Sign in / Sign up

Export Citation Format

Share Document