diagnostic agreement
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2021 ◽  
Author(s):  
S Vargas ◽  
K Konda ◽  
J Qquellon ◽  
F Vasquez ◽  
G Calvo ◽  
...  

2021 ◽  
Vol 3 (2) ◽  
pp. 78-90
Author(s):  
Tun Wang Ch’ng ◽  
Jin Poi Tan ◽  
Hilda Adnan Tassha ◽  
Bt Ja’afar Farrah ◽  
Bin Mt Saad Ahmad

Introduction: Optic nerve head imaging in myopic eyes with glaucoma is challenging due to atypical myopic optic disc morphology. Peripapillary retinal nerve fibre layer (pRNFL) and Bruch’s membrane opening-minimum rim width (BMO-MRW) utilize different anatomical reference points to measure the retinal nerve fibre layer. Purpose: To evaluate the diagnostic agreement between BMO-MRW and pRNFL in glaucomatous eyes with varying degrees of myopia. Design: Prospective observational study. Methods: Forty-three eyes diagnosed as primary open-angle glaucoma, normal-tension glaucoma, and primary angle-closure glaucoma with varying degrees of myopia were included in the study. Geometric measurement of the neuroretinal rim tissue was conducted with spectral domain optical coherence tomography (SD-OCT) usingtwo different parameters: BMO-MRW and pRNFL. The classification of scan quality and diagnostic agreement between both methods were compared using an exact McNemar’s test. The association between the summary classifications of quality scans with myopic degree was assessed with Fisher’s exact test. Results: BMO-MRW had a higher percentage of good quality image scans compared to pRNFL (p = 0.004). BMO-MRW was capable of obtaining equally good quality scans for glaucomatous eyes with various myopic degrees, whereas pRNFL demonstrated a significant statistical difference between mild, moderate, and high myopia(p = 0.001). pRNFL was difficult to identify in highly myopic eyes. By excluding poor quality scans, the diagnostic agreement between both modalities was 48.4% (p = 0.002). The observed agreement was higher in low myopia (66.7%), followed by moderate myopia (28.6%) and high myopia (16.7%). Conclusion: Compared to pRNFL, BMO-MRW is a better diagnostic imaging modality in glaucoma, especially for eyes with high myopia. Scan quality must be considered when interpreting OCT result in daily clinical practice to yield more accurate and reliable results.


Pulse ◽  
2021 ◽  
pp. 1-6
Author(s):  
Javier Rodríguez ◽  
Signed Prieto ◽  
Elveny Laguado ◽  
Frank Pernett ◽  
Magda Villamizar ◽  
...  

<b><i>Introduction:</i></b> Dynamical systems theory, probability, and entropy were the substrate for the development of the diagnostic and predictive methodology of adult heart dynamics. <b><i>Objective:</i></b> To apply a previously developed methodology from dynamical systems, probability, and entropy in both normal and pathological subjects. <b><i>Methods:</i></b> Electrocardiographic records were selected from 30 healthy subjects and 200 with different pathologies, with a length of least 18 h. Numerical attractors from dynamical attractors and the probability of occurrence of ordered pairs of consecutive heart rates were built. A calculation of entropy and its proportions was performed and statistical analysis was conducted. <b><i>Results:</i></b> The normal patients’ heart dynamics were evaluated according to the methodology of entropy proportions, highlighting that there are differences in normal patients with different pathologies. There was maximal level of sensitivity, specificity, and diagnostic agreement. <b><i>Conclusion:</i></b> Proportional entropy constitutes a diagnostic and predictive method of heart systems, and may be useful as a tool to objectively diagnose and perform the follow-up of normal and pathological cases.


2021 ◽  
Vol 94 (1120) ◽  
pp. 20201159
Author(s):  
Laura L. Wuyts ◽  
Michael Camerlinck ◽  
Didier De Surgeloose ◽  
Liesbet Vermeiren ◽  
David Ceulemans ◽  
...  

Objectives: To determine whether the revised 2018 ATS/ERS/JRS/ALAT radiological criteria for usual interstitial pneumonia (UIP) provide better diagnostic agreement compared to the 2011 guidelines. Methods: Cohort for this cross-sectional study (single center, nonacademic) was recruited from a multidisciplinary team discussion (MDD) from July 2010 until November 2018, with clinical suspicion of fibrosing interstitial lung disease (n= 325). Exclusion criteria were technical HRCT issues, known connective tissue disease (rheumatoid arthritis, systemic sclerosis, poly-or dermatomyositis), exposure to pulmonary toxins or lack of working diagnosis after MDD. Four readers with varying degrees in HRCT interpretation independently categorized 192 HRCTs, according to both the previous and current ATS/ERS/JRS/ALAT radiological criteria. An inter-rater variability analysis (Gwet’s second-order agreement coefficient, AC2) was performed. Results: The resulting Gwet’s AC2 for the 2011 and 2018 ATS/ERS/JRS/ALAT radiological criteria is 0.62 (±0.05) and 0.65 (±0.05), respectively. We report only minor differences in agreement level among the readers. Distribution according to the 2011 guidelines is as follows: 57.3% ‘UIP pattern’, 24% ‘possible UIP pattern’, 18.8% ‘inconsistent with UIP pattern’ and for the 2018 guidelines: 59.6% ‘UIP’, 14.5% ‘probable UIP’, 15.9% ‘indeterminate for UIP’ and 10% ‘alternative diagnosis’. Conclusions: No statistically significant higher degree of diagnostic agreement is observed when applying the revised 2018 ATS/ERS/JRS/ALAT radiological criteria for UIP compared to those of 2011. The inter-rater variability for categorizing the HRCT patterns is moderate for both classification systems, independent of experience in HRCT interpretation. The major advantage of the current guidelines is the better subdivision in the categories with a lower diagnostic certainty for UIP. Advances in knowledge: - In 2018, a revision of the 2011 ATS/ERS/JRS/ALAT radiological criteria for UIP was published, part of diagnostic guidelines for idiopathic pulmonary fibrosis. - The inter-rater agreement among radiologist is moderate for both classification systems, without a significantly higher degree of agreement when applying the revised radiological criteria.


Author(s):  
Tadesse HAILU ◽  
Endalkachew NIBRET ◽  
Arancha AMOR ◽  
Abaineh MUNSHEA ◽  
Melaku ANEGAGRIE

Background: Human infection with Strongyloides stercoralis and hookworm parasites is usually under reported due to less sensitive diagnostic methods. Agar plate culture (APC) is the most sensitive technique for parasites having larval stage. However, using APC in routine diagnosis is uncommon. This study aimed to determine the detection rate and sensitivity of APC in comparison with formal ether concentration technique (FECT) and spontaneous tube sedimentation techniques (STSTs) for S. stercoralis and hookworm larvae. Methods: Stool samples collected from 844 schoolchildren in Amhara Regional State, northwestern Ethiopia in 2019, transported to nearby health institutions and processed by APC, FECT and STSTs. The prevalence of S. stercoralis and hookworm was computed by descriptive statistics and Chi-square. The diagnostic agreement among the three techniques was evaluated using Kappa value. Results: The overall prevalence of S. stercoralis and hookworm infections by combining the three methods was 13.2% (111/844) and 33.8% (277/844), respectively. Using APC alone, the prevalence of S. stercoralis and hookworm were found to be 10.9% (92/844) and 24.5% (207/844), respectively. Agar plate culture was 5.4 and 2.7 times respectively more sensitive than FECT and STST, with slight and fair agreement in the detection of S. stercoralis. Hookworm diagnostic agreement was moderate between APC and FECT, and APC and STST. The Kappa value between STST and FECT diagnostic methods was substantial. Conclusion: APC has a better detection rate of S stercoralis and hookworm larvae. Therefore, APC can be used as an alternative routine diagnostic method to S. stercoralis and hookworm co-endemic countries.


2021 ◽  
Vol 7 ◽  
Author(s):  
Andrea Ronchi ◽  
Francesca Pagliuca ◽  
Federica Zito Marino ◽  
Giuseppe Argenziano ◽  
Gabriella Brancaccio ◽  
...  

The diagnosis of cutaneous melanoma and melanocytic neoplasms in general is one of the most challenging fields in pathology, and the reported interobserver diagnostic agreement in the evaluation of melanocytic lesions is poor. Nevertheless, a correct histopathological diagnosis is crucial to ensure a good clinical management of the patients. The institution of multidisciplinary teams has recently modified the approach to the patients with cutaneous melanoma. Patients referred to a multidisciplinary melanoma unit after receiving a diagnosis of melanoma elsewhere are encouraged to have their histopathological diagnosis confirmed by a second opinion from the experienced pathologist of the team before any treatment is initiated. We performed a retrospective analysis on a series of 121 histopathological revisions required for melanocytic neoplasms in the context of a multidisciplinary team, in order to evaluate the effects of second diagnostic opinion (SDO) on the clinical management of the patients. We defined three types of diagnostic discrepancies between the first diagnosis and the second opinion, according to the greatness of their clinical impact. Overall, the incidence of diagnostic discrepancies of any type was quite high in our series (56%). Interestingly, the SDO determined relevant changes in the clinical management of the patients in 33 out of 121 (27.3%) cases. This study confirms that SDO by expert pathologists significantly affects the course of treatment of melanoma patients and helps improving the diagnostic accuracy and clinical outcome.


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