Clinical validation of nursing diagnosis Fragile Elderly Syndrome

ABSTRACT Objective: to clinically validate the nursing diagnosis of NANDA-I Frail Elderly Syndrome in hospitalized elderly. Method: a methodological study, guided by the STROBE instrument, composed of 40 elderly people admitted to a teaching hospital in Paraíba, Brazil. The last phase of Hoskins’ Nursing Diagnostic Validation Model: clinical validation was adopted. Data collection took place from August to December 2018. The data were analyzed using univariate descriptive statistics. It was approved by the hospital’s ethics and research committee. Results: nine defining characteristics were validated; seven risk factors; six populations at risk and two associated conditions. Conclusion: the validation of the nursing diagnosis of the Frail Elderly Syndrome in our socio-cultural context was considered appropriate, being an important step for critical thinking that underlies the decision-making of nurses in the care of the frail elderly, as well as professional practice.

Validation and implementation of a direct RT-qPCR method for rapid screening of SARS-CoV-2 infection by using non-invasive saliva samples

BackgroundThere is an urgent need to curb COVID-19 pandemic through early identification of asymptomatic but infectious cases. We aimed to validate and implement an optimised screening method for detection of SARS-CoV-2 RNA combining use of self-collected raw saliva samples, single-step heat-treated virus inactivation and RNA extraction, and direct RT-qPCR.Methods and findingsThe study was conducted in Sant Joan de Deu University Hospital (Barcelona, Spain), including: i) analytical validation against standard RT-qPCR in saliva samples; ii) diagnostic validation against standard RT-qPCR using paired saliva-nasopharyngeal samples obtained from asymptomatic teenagers and young and older adults in a youth sports academy; and iii) high throughput pilot screening of asymptomatic health workers and other staff in the study site.The proposed method had comparable analytical performance to standard RT-qPCR in saliva. Diagnostic validation included saliva samples self-collected with supervision by 173 participants during 9-12 weeks and nasopharyngeal samples collected from them. At baseline, all participants (100.0%) were negative for SARS-CoV-2 in both paired saliva-nasopharyngeal samples. In the following weeks, standard RT-qPCR yielded 23 positive results in nasopharyngeal samples whereas paired saliva specimens yielded 22 (95.7%) positive and one inconclusive result.A total of 2,709 participants engaged in the pilot screening, with high rate of participation (83.4% among health workers). Only 17 (0.6%) of saliva samples self-collected by participants in an unsupervised manner were invalid. Saliva was positive in 24 (0.9%) out of 2,692 valid specimens and inconclusive in 27 (1.0%). All 24 saliva-positive participants and 4 with saliva inconclusive results were positive by standard RT-qPCR in nasopharyngeal samples. The pilot showed potential for rapid analytical workflow (up to 384 batched samples can be processed in <2 hours).ConclusionDirect RT-qPCR on self-collected raw saliva is a simple, rapid, and accurate method with potential to be scaled up for enhanced SARS-CoV-2 community-wide screening.

Development and validation of lupus nephritis case definitions using United States veterans affairs electronic health records

Objective International Classification of Diseases (ICD) codes are commonly used to identify patients with rare diseases in electronic health records (EHRs). However, misclassification is common, impacting the validity of study results. In this study, we compared the accuracies of several ICD-based case definitions of lupus nephritis (LN) in identifying United States veterans with LN. Methods Using the Department of Veterans Affairs (VA) EHR, we identified all veterans with ≥1 ICD-9 or 10 diagnostic codes for systemic lupus erythematosus (SLE) between October 1, 1999 and September 30, 2017. A cohort was randomly selected for diagnostic validation and 9 ICD-based LN case definitions were applied to this cohort. The diagnostic accuracy of each definition was assessed against gold standard criterion of biopsy-proven LN. Results 18,420 veterans had ≥1 ICD-9 or 10 diagnostic codes for SLE; 981 were randomly selected for diagnostic validation. 95 veterans (9.7%) had biopsy-proven LN. The case definitions had high specificity and NPV but variable sensitivity and PPV. The definition containing ≥2 ICD -9 codes for SLE and ≥2 nephritis indicators had the highest combination of sensitivity and specificity (87.4% and 94.6% respectively). ICD-10 code for LN had high specificity (99.8%) and PPV (93.9%). Conclusion ICD-based case definitions of LN in the VA population have high specificity and NPV but variable sensitivity and PPV. Our results may help guide the design of future LN studies in VA cohorts. The choice of specific case definitions depends on the relative importance of different accuracy measures to individual studies.

Clinical features to distinguish meningitis among young infants at a rural Kenyan hospital

BackgroundDetection of meningitis is essential to optimise the duration and choice of antimicrobial agents to limit mortality and sequelae. In low and middle-income countries most health facilities lack laboratory capacity and rely on clinical features to empirically treat meningitis.ObjectiveWe conducted a diagnostic validation study to investigate the performance of clinical features (fever, convulsions, irritability, bulging fontanel and temperature ≥39°C) and WHO-recommended signs (drowsiness, lethargy, unconsciousness, convulsions, bulging fontanel, irritability or a high-pitched cry) in discriminating meningitis in young infants.DesignRetrospective cohort study.SettingKilifi County Hospital.PatientsInfants aged <60 days hospitalised between 2012 and 2016.Main outcome measureDefinite meningitis defined as positive cerebrospinal fluid (CSF) culture, microscopy or antigen test, or leucocytes ≥0.05 x 10∧9/L.ResultsOf 4809 infants aged <60 days included, 81 (1.7%) had definite meningitis. WHO-recommended signs had sensitivity of 58% (95% CI 47% to 69%) and specificity of 57% (95% CI 56% to 59%) for definite meningitis. Addition of history of fever improved sensitivity to 89% (95% CI 80% to 95%) but reduced specificity to 26% (95% CI 25% to 27%). Presence of ≥1 of 5 previously identified signs had sensitivity of 79% (95% CI 69% to 87%) and specificity of 51% (95% CI 50% to 53%).ConclusionsDespite a lower prevalence of definite meningitis, the performance of previously identified signs at admission in predicting meningitis was unchanged. Presence of history of fever improves the sensitivity of WHO-recommended signs but loses specificity. Careful evaluation, repeated assessment and capacity for lumbar puncture and CSF microscopy to exclude meningitis in most young infants with potential signs are essential to management in this age group.