Best Combination Of Sensitivity Research Articles

Prediction of new-onset atrial fibrillation with the C2HEST score in patients admitted with community-acquired pneumonia.

Patients hospitalized for community-acquired pneumonia (CAP) may have a higher risk of new-onset atrial fibrillation (NOAF). The C2HEST score was developed to evaluate the NOAF risk in the general population. Data on the value of the C2HEST score in acute patients admitted with CAP are lacking. We want to establish the predictive value of C2HEST score for NOAF in patients with CAP. Patients with CAP enrolled in the SIXTUS cohort were enrolled. C2HEST score was calculated at baseline. In-hospital NOAF was recorded. Receiver-operating Characteristic (ROC) curve and multivariable Cox proportional hazard regression analysis were performed. We enrolled 473 patients (36% women, mean age 70.6 ± 16.5years), and 54 NOAF occurred. Patients with NOAF were elderly, more frequently affected by hypertension, heart failure, previous stroke/transient ischemic attack, peripheral artery disease and hyperthyroidism. NOAF patients had also higher CURB-65, PSI class and CHA2DS2-VASc score. The C-index of C2HEST score for NOAF was 0.747 (95% confidence interval [95%CI] 0.705-0.786), higher compared to CURB-65 (0.611, 95%CI 0.566-0.655, p = 0.0016), PSI (0.665, 95%CI 0.621-0.708, p = 0.0199) and CHA2DS2-VASc score (0.696, 95%CI 0.652-0.737, p = 0.0762). The best combination of sensitivity (67%) and specificity (70%) was observed with a C2HEST score ≥ 4. This result was confirmed by the multivariable Cox analysis (Hazard Ratio [HR] for C2HEST score ≥ 4 was 10.7, 95%CI 2.0-57.9; p = 0.006), independently from the severity of pneumonia. The C2HEST score was a useful predictive tool to identify patients at higher risk for NOAF during hospitalization for CAP. www. gov (NCT01773863).

Impulse oscillometry bronchodilator response in preschool children.

In preschoolers, performing an acceptable spirometry and measuring bronchodilator response (BDR) is challenging; in this context, impulse oscillometry (IOS) represents a valid alternative. However, more studies on the standardization of BDR for IOS in young children are required. The objective of the study was to identify optimal thresholds to define a positive BDR test with IOS in preschoolers with suspected asthma. Children aged 3-6 years with suspected asthma and their lung function investigated with both IOS and spirometry pre- and post-BDR were retrospectively analyzed. The spirometric BDR was defined as positive when the change of FEV1 was ≥12% or ≥200 mL. The oscillometric BDR was defined as positive in case of change of at least -40% in R5, +50% in X5, and -80% in AX. Among 72 patients, 36 (age 5.2 ± 1 years; 64% boys) were selected for the subsequent analysis according to ATS/ERS quality criteria of measurements; specifically, 19 patients did not meet IOS and 36 did not meet spirometry criteria. The spirometric BDR was found positive in seven subjects (19.4%); conversely, a positive oscillometric BDR was identified in four patients (11.1%). No patient presented a positive BDR response with both methods. In IOS, the mean decrease in R5 and AX was 19.9% ± 10% and 44% ± 22.1%, and the mean increase in X5 was 23.3% ± 17.8%, respectively. A decrease in R5 of 25.7% (AUC 0.77, p = .03) and an increase in X5 of 25.7% (AUC 0.75, p = .04) showed the best combination of sensitivity and specificity to detect an increase of FEV1 ≥ 12% and/or ≥200 mL. The IOS represents a valid alternative to spirometry to measure BDR in preschool children and should be the gold standard in this age group. We are considering a decrease of 26% in R5 and an increase of 26% in X5 as diagnostic threshold for BDR.

Diagnostic Utility of Integration of Dynamic Contrast-Enhanced and Dynamic Susceptibility Contrast MR Perfusion Employing Split Bolus Technique in Differentiating High-Grade Glioma

Abstract Background: Despite documented correlation between glioma grades and dynamic contrast-enhanced (DCE) magnetic resonance (MR) perfusion-derived parameters, and its inherent advantages over dynamic susceptibility contrast (DSC) perfusion, the former remains underutilized in clinical practice. Given the inherent spatial heterogeneity in high-grade diffuse glioma (HGG) and assessment of different perfusion parameters by DCE (extravascular extracellular space volume [Ve] and volume transfer constant in unit time [k-trans]) and DSC (rCBV), integration of the two into a protocol could provide a holistic assessment. Considering therapeutic and prognostic implications of differentiating WHO grade 3 from 4, we analyzed the two grades based on a combined DCE and DSC perfusion. Methods: Perfusion sequences were performed on 3-T MR. Cumulative dose of 0.1 mmol/kg of gadodiamide, split into two equal boluses, was administered with an interval of 6 minutes between the DCE and DSC sequences. DCE data were analyzed utilizing commercially available GenIQ software. Results: Of the 41 cases of diffuse gliomas analyzed, 24 were WHO grade III and 17 grade IV gliomas (2016 WHO classification). To differentiate grade III and IV gliomas, Ve cutoff value of 0.178 provided the best combination of sensitivity (88.24%) and specificity (87.50%; AUC: 0.920; p < 0.001). A relative cerebral blood volume (rCBV) of value 3.64 yielded a sensitivity of 70.59% and specificity of 62.50% (p = 0.018). The k-trans value, although higher in grade III than in grade IV gliomas, did not reach statistical significance (p = 0.108). Conclusion: Uniqueness of employed combined perfusion technique, treatment naïve patients at imaging, user-friendly postprocessing software utilization, and ability of Ve and rCBV to differentiate between grade III and IV gliomas (p < 0.05) are the strengths of the present study, contributing to the existing literature and moving a step closer to achieving accurate MR perfusion-based glioma grading.

A Study of the Usefulness of Tissue Doppler Imaging for the Diagnosis of Coronary Artery Disease in Patients with Left Bundle Branch Block

Abstract Background: In patients with left bundle branch block (LBBB), the diagnosis of ischemia by noninvasive modalities is cumbersome. Most of them such as stress tests, nuclear imaging, and magnetic resonance imaging have limitations in the detection of ischemia in this subset. The postsystolic motion (PSM) during the isovolumetric relaxation period on tissue Doppler imaging (TDI) is a sensitive and specific marker of ischemia. We aimed to see whether the TDI parameters can detect coronary artery disease (CAD) in patients with LBBB. Materials and Methods: Patients with LBBB (n = 64) who underwent coronary angiography were divided into two groups. Group A (n = 30) included patients with left anterior descending (LAD) artery stenosis of ≥70%, and group B (n = 34) included patients without LAD stenosis. All patients underwent TDI and various myocardial tissue velocity parameters were analyzed to detect the presence of CAD. P < 0.05 was considered significant. Results: The TDI of the mid-interventricular septum showed a higher delayed amplitude of PSM (>100 ms after aortic valve closure), lower myocardial systolic (Sm), and early diastolic (Em) velocities, and a higher late diastolic (Am) velocity in group A when compared to group B (all were significant, P < 0.0001). Both the ratios Sm/PSM and Em/Am were significantly lower in group A compared to group B (P < 0.0001). On receiver operating characteristic curve analysis to predict the presence of significant LAD stenosis, the value of Sm/PSM ratio <0.8 showed the best combination of sensitivity (78%) and specificity (96%) with an area under the curve of 0.936. Conclusion: TDI, a noninvasive imaging modality, is reliable and effective in identifying myocardial ischemia in patients with LBBB.

Trials and tribulations: Developing an artificial intelligence for screening malaria parasite from peripheral blood smears

BackgroundDetection of malaria parasite from blood smears remains the gold standard for confirmation of diagnosis. Screening blood smears for malaria parasite has a sensitivity of 75 %, and requires intensive training of the laboratory technician. In the present study, we have attempted to develop an artificial intelligence to automate the process of malaria parasite detection. MethodsWe acquired 352 images of Leishman–Giemsa-stained peripheral blood smears, containing either normal red blood cells (RBCs) or parasitised RBCs. With a trial and error approach, we developed five deep learning models: (A) Naive deep convolutional neural network (DCNN) for trophozoites, (B) Modified Inception V3 pretrained neural network (C) Combination of model A and B, (D) Segmentation of cells from the images through Watershed Transform and naive tri-class DCNN (normal RBCs, parasitised RBCs, WBC/platelets), and (E) A naive DCNN model to detect ring forms. The images were randomly split into training and test sets and training was imparted on all the models. After completion of training, performance of each model was assessed on the test set. ResultsOverall, the best combination of sensitivity and specificity was seen in model D (85 % and 94 %, respectively) in detecting parasites; in addition to trophozoites, model D could also detect ring forms. The performance of model A, B & C suffered from lack of either sensitivity or specificity. ConclusionThe present study represents the first step towards development of a complete module for screening malaria parasites from automated microphotography/whole slide images.

Abstract 17264: PFO Cover Index by 3D-TEE Predicts Residual Shunting After Transcatheter Closure

Introduction: Proper defect sizing and device size selection are imperative for ensuring successful clinical outcomes after transcatheter patent foramen ovale (PFO) closure. However, with current sizing techniques, residual shunting remains as high as 25% and is associated with an increased risk of recurrent neurologic events. Since 2017, we adopted a PFO sizing strategy based on right atrial (RA) tunnel “width” oversizing utilizing three-dimensional transesophageal echocardiography (3D-TEE). Hypothesis: We hypothesized that the PFO tunnel width at the RA opening and a cover index based on this dimension would predict residual shunting at long term follow-up. Methods: Sixty-four patients underwent transcatheter PFO closure (60 patients utilizing a 3D-TEE based oversizing strategy) at our institution between 2015 and 2022. PFO tunnel length, tunnel width at RA opening, and tunnel width at left atrial opening were determined by 3D-TEE either before or at the time of closure. We determined an absolute PFO “cover index” for each patient as follows: RA disc diameter - RA tunnel width. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive ability of 3D-TEE derived PFO dimensions and the PFO cover index to predict residual shunting at follow-up. Results: Fifty-one of sixty-four patients had a long-term follow-up bubble study (mean follow-up time 8.0±3.7 months). Of the 47 patients closed utilizing a 3D-TEE based sizing strategy and with a follow-up bubble study, only 5 patients (10.6%) had residual shunting at follow-up. Of the three 3D-TEE based PFO dimensions, only the RA tunnel width was predictive of residual shunting at follow-up (AUC 0.84, p=0.004). A cutoff of 15.5 mm or greater for RA tunnel width had the best combination of sensitivity (86%) and specificity (73%). The PFO cover index was also strongly predictive of residual shunting at follow-up (AUC 0.87, p=0.002). A cutoff of 9.5 mm or less had the best combination of sensitivity (86%) and specificity (82%). Conclusions: A larger PFO tunnel width at the right atrial opening and a lower cover index based on this dimension predict residual shunting at follow-up. Our findings have important implications for improving sizing strategies for transcatheter PFO closure.

Performance of Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment in screening for cancer-related malnutrition in Nairobi, Kenya

Background Malnutrition is a common feature among oncology patients. It is responsible for poor response and tolerance to anticancer therapy, increased morbidity, and mortality. More than half of malnourished cancer patients remain undetected owing to lack of effective screening. Body mass index is the main indicator for assessing malnutrition in Kenyan public hospitals. However, it underestimates weight loss in patients with chronic illnesses. The Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment have been widely used in research and clinical practice and have both reported good validity and reliability. However, their diagnostic evaluation has not been performed in Kenya. Methods A cross-sectional study was conducted among 138 and 76 cancer outpatients from Kenyatta National Hospital and Texas cancer treatment centres, respectively. Participants had a confirmed disease, stage 1-4 cancer, and aged 18 years and above. They were screened for malnutrition using both Malnutrition Universal Screening Tool and Patient Generated-Subjective Global Assessment. A separate study questionnaire was utilized to gather participant’s socio-demographic and clinical characteristics. A Bayesian latent class modelling framework was employed to infer the tests’ estimates based on participants ‘cumulative scores from the two tests. Results The cut-off value of ≥ 1 and ≥ 4 gave the best combination of sensitivity and specificity of Malnutrition Universal Screening Tool and Patient Generated-Subjective Global Assessment. Both tests yielded statistically similar sensitivities and specificities. Predictive values were comparable between the tests and across the two populations. The posterior median true prevalences of malnutrition were high (˃ 54%) and numerically similar between the studied populations. Conclusions The performance of both tests among patients with cancer is similar. Healthcare workers are therefore at liberty to use either of them to inform treatment. Given the high true prevalence of cancer-related malnutrition, routine screening is critical and should be included as part of cancer care.

Validating the predictive ability of the 2MACE score for major adverse cardiovascular events in patients with atrial fibrillation: results from phase II/III of the GLORIA-AF registry

The 2MACE score was specifically developed as a risk-stratification tool in atrial fibrillation (AF) to predict cardiovascular outcomes. We evaluated the predictive ability of the 2MACE score in the GLORIA-AF registry. All eligible patients from phase II/III of the prospective global GLORIA-AF registry were included. Major adverse cardiac events (MACEs) were defined as the composite outcome of stroke, myocardial infarction and cardiovascular death. Cox proportional hazards were used to examine the relationship between the 2MACE score and study outcomes. Predictive capability of the 2MACE score was investigated using receiver-operating characteristic curves. A total of 25,696 patients were included (mean age 71 years, female 44.9%). Over 3 years, 1583 MACEs were recorded. Patients who had MACE were older, with more cardiovascular risk factors and were less likely to be managed using a rhythm-control strategy. The median 2MACE score in the MACE and non-MACE groups were 2 (IQR 1–3) and 1 (IQR 0–2), respectively (p < 0.001). The 2MACE score was positively associated with an increase in the risk of MACE, with a score of ≥ 2 providing the best combination of sensitivity (69.6%) and specificity (51.6%), HR 2.47 (95% CI, 2.21–2.77). The 2MACE score had modest predictive performance for MACE in patients with AF (AUC 0.655 (95% CI, 0.641–0.669)). Our analysis in this prospective global registry demonstrates that the 2MACE score can adequately predict the risk of MACE (defined as myocardial infarction, CV death and stroke) in patients with AF. Clinical trial registration:http://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007 and NCT01937377

Validity of a self-administered G8 screening test for older patients with cancer

IntroductionThe Geriatric 8 (G8) is a brief cancer-specific tool which screens for patients who require a comprehensive geriatric assessment (CGA). The G8 test assesses patients on eight domains such as mobility, polypharmacy, age, and self-rated health. However, the current G8 requires a healthcare professional (nurse or physician) present to conduct the test, which limits its usefulness. The Self-G8 questionnaire (S-G8) is an adaptation of the original G8 test, assessing all the same domains, with questions modified to be appropriate for patients to self-complete. Our objective was to evaluate the performance of S-G8 compared to the G8 and CGA. Materials and MethodsThe initial S-G8 was designed by our team through review of the literature and questionnaire design principles, and was optimized through feedback from patients over the age of 70. The questionnaire subsequently underwent further refinement after undergoing pilot testing (N = 14). The diagnostic accuracy of the final iteration of the S-G8 was evaluated along with the standard G8 in a prospective cohort study (N = 52) in an academic geriatric oncology clinic at the Princess Margaret Cancer Centre, Toronto, Canada. Psychometric characteristics were evaluated including internal consistency, sensitivity, and specificity compared to the G8 and to the CGA. ResultsThere was strong correlation between the G8 and S-G8 scores, with a Spearman correlation co-efficient of 0.76 (p < 0.001). Internal consistency was acceptable at 0.60. The frequency of abnormality (<14 score) for the G8 and S-G8 was 82.7% and 61.5%, respectively. The mean score for the original G8 and S-G8 was 11.9 and 13.5, respectively. The cut-off of 14 for the S-G8 yielded the best combination of sensitivity of 0.70 ± 0.07 and specificity of 0.78 ± 0.14 when compared to the G8. When compared to two or more abnormal domains on the CGA, the S-G8 performed at least as well as the G8 with a sensitivity of 0.77, specificity of 0.85, and a Youden's index of 0.62. DiscussionThe S-G8 questionnaire appears to be an acceptable alternative to the original G8 in identifying older adults with cancer who will benefit from a CGA. Large scale testing is warranted.

Use of CAPTURE to Identify Individuals Who May or May Not Require Treatment for COPD.

The COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) tool was developed to identify patients with undiagnosed COPD with FEV1 <60% predicted or risk of exacerbation as treatment criteria. To test the ability of CAPTURE to identify patients requiring treatment because of symptoms or risk of exacerbation or hospitalization. Data were from COMPASS, a prospective study in China of COPD, chronic bronchitis without airflow limitation (post-bronchodilator FEV1/FVC >0.70), and healthy never-smokers. CAPTURE was tested as questions alone and with peak expiratory flow (PEF). Sensitivity, specificity, positive and negative predicted values (PPV and NPV) were calculated for CAT ≥10 vs <10, mMRC ≥2 vs <2, and ≥1 moderate exacerbation or hospitalization vs none in the previous year. COPD patients (n=1696), mean age 65±7.5 years, 90% males, post-bronchodilator FEV1 66.5±20.1% pred; controls (n=307), age 60.2±7.0 years, 65% males, FEV1/FVC 0.78±0.04. CAPTURE using PEF showed the best combination of sensitivity and specificity. Sensitivity and specificity to detect CAT ≥10 were 68.5% and 64.0%, respectively; mMRC ≥2 (85.6% and 61.0%), ≥1 moderate exacerbation (63.5% and 55.6%) and hospitalization (70.2% and 59.4%). PPV ranged 15.6% (moderate exacerbations) to 47.8% (CAT). NPV ranged 80.8% (CAT) to 95.6% (mMRC). CAPTURE has good sensitivity to identify COPD patients who may require treatment because of elevated symptoms, risk of exacerbations or hospitalization, including those with FEV1 >60% predicted. High NPV values show it can also exclude those who may not require treatment. GSK (208630).

Time course of sutural width during the physiological growth from birth to adulthood: CT quantitative and qualitative evaluations of sutural arches.

We performed a retrospective qualitative and quantitative evaluation of the sutural changes during the physiological growth to define the age-related ossification stages of major and minor skull sutures or synchondroses. A total of 390 healthy subjects, examined for cranio-facial trauma and whose CT scans turned out to be normal, were clustered into homogenous age-matched groups ranged from birth to 90years. High-resolution CT was used to assess the degree of sutural closure according to a 3-grade scoring system, the sutural pattern, the width, and the density of the gap calculated as the average of two or three ROIs along each suture/synchondrosis. The identification of a definite pattern depended on the suture's type, the closure degree, and the width of the gap (p < 0.001). The interdigitation process was more intricate for most of vault sutures than the skull base sutures/synchondroses. Closing grades 1, 2, and 3 were associated to an identifiable sutural pattern and the cutoff value of 1.45mm of the gap width allowed to detect an identifiable sutural pattern with the best combination of sensitivity (97%) and specificity (98%). Age and sutural closing degree were inversely related to gap width while positively related to the gap density (p < 0.001). The sutural ossification is an age-related process, distinctive for each suture, and synchondrosis; it occurs neither according to a predefined order along sutural arches nor following a sequential distribution in the cranial fossae, and some sutures continued their growth process during lifetime.

Validation of a guideline to reduce variability in diagnosing cervical dystonia

BackgroundCervical dystonia is characterized by a variable pattern of neck muscle involvement. Due to the lack of a diagnostic test, cervical dystonia diagnosis is based on clinical examination and is therefore subjective. The present work was designed to provide practical guidance for clinicians in confirming or refuting suspected cervical dystonia.MethodsParticipants were video recorded according to a standardized protocol to assess 6 main clinical features possibly contributing to cervical dystonia diagnosis: presence of repetitive, patterned head/neck movements/postures inducing head/neck deviation from neutral position (item 1); sensory trick (item 2); and red flags related to conditions mimicking dystonia that should be absent in dystonia (items 3–6). Inter-/intra-rater agreement among three independent raters was assessed by k statistics. To estimate sensitivity and specificity, the gold standard was cervical dystonia diagnosis reviewed at each site by independent senior neurologists.ResultsThe validation sample included 43 idiopathic cervical dystonia patients and 41 control subjects (12 normal subjects, 6 patients with isolated head tremor, 4 with chorea, 6 with tics, 4 with head ptosis due to myasthenia or amyotrophic lateral sclerosis, 7 with orthopedic/rheumatologic neck diseases, and 2 with ocular torticollis). The best combination of sensitivity and specificity was observed considering all the items except for an item related to capability to voluntarily suppress spasms (sensitivity: 96.1%; specificity: 81%).ConclusionsAn accurate diagnosis of cervical dystonia can be achieved if, in addition to the core motor features, we also consider some clinical features related to dystonia mimics that should be absent in dystonia.

Diagnostic accuracy of the Hammersmith Neonatal Neurological Examination in predicting motor outcome at 12 months for infants born very preterm.

To evaluate the predictive validity of the Hammersmith Neonatal Neurological Examination (HNNE) performed early (at 32 weeks postmenstrual age) and at term-equivalent age (TEA) for 12-month motor outcomes in infants born very preterm. This was a diagnostic study using data from a prospective birth cohort. A total of 104 infants born preterm at less than 31 weeks gestational age (males n=61; mean=28 weeks 1 day [SD 1 week 6 days], range 23 weeks 1 day-30 weeks 6 days) underwent HNNE early and at TEA, which were scored by comparison with term data. Motor outcomes at 12 months corrected age were determined using the Bayley Scales of Infant and Toddler Development, Third Edition (scores ≤85). Cut-off points were determined using receiver operating characteristic curves. Sixteen (15%) infants born preterm had motor impairment at 12 months corrected age. The HNNE total score cut-off points with the best combination of sensitivity and specificity at early and TEA assessments were 15.2 or lower (sensitivity 77%, 95% confidence interval [CI]=46%-95%; specificity 74%, 95% CI=63%-83%) and 23.5 or lower (sensitivity 67%, 95% CI=38%-88%; specificity 66%, 95% CI=54%-76%) respectively. The most predictive subscale at the early assessment was reflexes (sensitivity 86%, 95% CI=57%-98%; specificity 62%, 95% CI=51%-72%; cut-off point ≤3); at TEA, it was spontaneous movements (sensitivity 73%, 95% CI=45%-92%; specificity 60%, 95% CI=48%-70%; cut-off point ≤2). The HNNE provides moderate predictive accuracy for motor outcome at 12 months corrected age in infants born very preterm. Although modest at both time points, early assessment had stronger predictive ability for motor outcomes than TEA when scored using term data, highlighting the value of performing the HNNE earlier in the neonatal period. Performing HNNE earlier may assist risk stratification when planning follow-up services.

Cognitive reserve in patients with mood disorders: Validation study of the Chinese version of the cognitive reserve assessment scale in health

BackgroundCognitive reserve (CR) is closely associated with cognitive and functional outcome, disease severity, progression and prognosis in psychiatric patients; however, it has not been extensively tested in mood disorders. This study examined the psychometric properties of the Cognitive Reserve Assessment Scale in Health (CRASH) in mood disorder patients. MethodsAltogether 166 subjects were recruited, 44 with major depressive disorder (MDD), 64 with bipolar disorder (BD), and 58 healthy controls. CR was assessed using the CRASH and the Cognitive Reserve Questionnaire (CRQ). ResultsInternal consistency (Cronbach's alpha) was 0.779 for the CRASH. The Receiver Operating Characteristic (ROC) curve analysis revealed an area under the ROC curve (AUC) value of 0.73 (95 % CI: 0.647–0.809). The optimal cut-off score of 51 generated the best combination of sensitivity (0.78) and specificity (0.43) for discriminating between patients with mood disorders and healthy controls. The CRASH score was highly correlated with the CRQ score in both mood disorder patients (rs = 0.586, P < 0.001) and healthy controls (rs = 0.627, P < 0.001), indicating acceptable convergent validity for the CRASH. Within the mood disorder sample, the CRASH score was associated with functional outcomes (FAST: rs = −0.243, P = 0.011). ConclusionsThe CRASH is a useful tool to measure CR in mood disorder with acceptable psychometric properties and could be used in both research and clinical practice.

Performance analysis considering endpoints for three accelerated diagnostic protocols for chest pain

IntroductionThe modified accelerated diagnostic protocol (ADP) to assess patients with chest pain symptoms using troponin as the only biomarker (mADAPT), the History, ECG, Age, Risk factors, and Troponin (HEART) pathway, and the Emergency Department Assessment of Chest Pain Rule (EDACS)-ADP, are the three most well-known ADPs for patients with chest pain. These ADPs define major adverse cardiac event (MACE) as components of acute myocardial infarction, revascularization, and death; unstable angina is not included as an endpoint. MethodsWe performed a single-center prospective observational study comparing the performance of these 3 ADPs for patients with 30-day MACE with and without unstable angina. We hypothesized that these ADPs will have high sensitivities for MACE without unstable angina, a definition used for score derivation studies. However, when unstable angina is included in the MACE, their performances would be lower than the acceptable rate of >99% sensitivity. ResultsA total of 1,214 patients were included in the analysis. When unstable angina was not included in the endpoint, sensitivities for MACE were 99.1% (95% confidence interval [CI]: 96.7–99.9%), 99.5% (95% CI: 97.4–100%), and 100% (95% CI: 98.3–100%) for mADAPT, EDACS-ADP, and HEART pathway, respectively. The HEART pathway had the highest proportion of patients classified as low risk (39.2%, 95% CI: 35.8–42.9%), followed by EDACS-ADP (31.3%, 95% CI: 28.2–34.6%) and mADAPT (29.3%, 95% CI: 26.4–32.5%). However, when unstable angina was included in the MACE, sensitivities were 96.6% (95% CI: 94.4–98.1%) for mADAPT, 97.3% (95% CI: 95.3–98.6%) for EDACS-ADP, and 97.3% (95% CI: 95.3–98.6%) for the HEART pathway, respectively. There were 15 false-negative cases with mADAPT, and 12 false-negative cases each for EDACS-ADP and HEART pathway. ConclusionAll three ADPs—mADAPT, EDACS-ADP, and HEART pathway—were similarly accurate in their discriminatory performance for the risk stratification of ED patients presenting with possible ACS when unstable angina was not included in the endpoint. The HEART pathway showed the best combination of sensitivity and proportion of patients that can be classified as safe for early discharge. However, when unstable angina was added to the endpoint, all three ADPs did not show appropriate safety levels and their performances were lower than the acceptable risk of MACE.

Thirty-Minute Post-load Glucose Could Be a Useful Screening Measure for Abnormal Oral Glucose Tolerance Test Response in Adolescents with Obesity

BackgroundWith the growing obesity epidemic, subjecting every child with obesity to a 2-hour oral glucose tolerance test (OGTT) is impractical. Instead, 30-minute plasma glucose (PG), which reflects the acute phase of insulin secretion, might be a useful measure in the initial assessment of such individuals. Our study aimed to evaluate the optimal cutoff of 30-minute PG in predicting abnormal OGTT response and to compare the predictive value of this cutoff with that of the previously reported values from a combination of non-fasting parameters.MethodsFor this study, 332 overweight or obese pediatric individuals who had undergone the OGTT under the Department of Pediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong, from 2012 to 2018 were included. The optimal cutoff of 30-minute PG for prediction of abnormal OGTT response was determined using a receiver operating characteristics curve, and the positive predictive value (PPV) was evaluated.ResultsThere were 180 males (54.2%) and the mean age of the included individuals was 15.4±2.3 years. A 30-minute PG ≥9.2 mmol/L predicts abnormal OGTT response with the best combination of sensitivity and specificity. The PPV for abnormal OGTT response at this cutoff was 45%. Addition of this 30-minute PG cutoff to non-fasting parameters, including glycated hemoglobin, abnormal alanine transaminase, and family history of diabetes, resulted in an improved PPV of 70% for abnormal OGTT response.ConclusionAddition of 30-minute PG to non-fasting parameters improved the clinical utility in identifying high-risk individuals for abnormal OGTT response.

A-231 Can Embedded Performance Validity Measures Predict Performance on a Stand-Alone Test?

Abstract Objective: Determine the extent to which a group of embedded performance validity tests (PVT) predict performance on a stand-alone test; and examine the classification accuracy of embedded PVTs. Method: Participants were 102 adult patients who underwent neuropsychological evaluation (M age = 31.85, SD = 11.79; M education = 13.82, SD = 2.50; M FSIQ = 104.72). Patients were administered the Medical Symptom Validity Test (MSVT), and 10 embedded PVT scores were extracted from their neuropsychological profiles. Logistic regression determined the extent to which scores on embedded PVTs predicted MSVT designation as credible or noncredible. Classification accuracy also was calculated for the embedded PVTs, both individually and based on number of “failures.” Results: A final regression model (Chi-square (6) = 20.06, p = .003, Nagelkerke R Square = .42) was 38% sensitive, 97% specific, and correctly predicted credible patients (negative predictive accuracy = 95%) more often than noncredible patients (positive predictive accuracy = 50%). Several embedded PVTs had comparable classification accuracy. Conservatively defining noncredible performance as failure on at least three embedded PVTs produced the best combination of sensitivity (50%) and specificity (86%), and was associated with a false positive rate of 14%. Conclusions: Embedded PVTs correctly predict credible and noncredible performance on the MSVT at a high level. Although a multivariate predictive approach may have slightly more utility than examining embedded PVT scores separately, several individual PVTs have comparable accuracy. It remains unclear which approach is superior, and more research is needed.

Performance of Malnutrition Universal Screening Tool and Patient-Generated Global Subjective Assessment in screening for cancer-related malnutrition in Nairobi, Kenya

Background: Malnutrition is a common feature among oncology patients. It is responsible for poor response and tolerance to anticancer therapy, increased morbidity, and mortality. More than half of malnourished cancer patients remain undetected owing to lack of effective screening. Body mass index is the main indicator for assessing malnutrition in Kenyan public hospitals. However, it underestimates weight loss in patients with chronic illnesses. The Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment have been widely used in research and clinical practice and have both reported good validity and reliability. However, their diagnostic evaluation has not been performed in Kenya. Methods: A cross-sectional study was conducted among 138 and 76 cancer outpatients from Kenyatta National Hospital and Texas cancer treatment centres, respectively. Participants had a confirmed disease, stage 1-4 cancer, and aged 18 years and above. They were screened for malnutrition using both Malnutrition Universal Screening Tool and Patient Generated-Subjective Global Assessment. A separate study questionnaire was utilized to gather participant’s socio-demographic and clinical characteristics. A Bayesian latent class modelling framework was employed to infer the tests’ estimates based on participants ‘cumulative scores from the two tests. Results: The cut-off value of ≥ 1 and ≥ 4 gave the best combination of sensitivity and specificity of Malnutrition Universal Screening Tool and Patient Generated-Subjective Global Assessment. Both tests yielded statistically similar sensitivities and specificities. Predictive values were comparable between the tests and across the two populations. The posterior median true prevalences of malnutrition were high (˃ 54%) and numerically similar between the studied populations. Conclusions: The performance of both tests among patients with cancer is similar. Healthcare workers are therefore at liberty to use either of them to inform treatment. Given the high true prevalence of cancer-related malnutrition, routine screening is critical and should be included as part of cancer care.

Validation of the 33-Item Hypomania Checklist-External Assessment in Screening Adolescents for Bipolar Disorder.

BackgroundBipolar disorder (BD) is often misdiagnosed, leading to poor treatment outcomes. Thus, accurate assessment of BD is of great importance, including in BD adolescents. The aim of the study was to explore the psychometric properties of the 33-item Hypomania Checklist-External Assessment (HCL-33-EA) in depressed adolescents.MethodsThe study was conducted between March and November 2020 in Beijing, China. Depressed adolescents aged between 13 and 17 years (N = 260) with BD (N = 147) or major depressive disorder (MDD) (N = 113) diagnosed according to the International Classification of Diseases, Tenth Revision (ICD-10) were recruited. Patients’ hypomanic symptoms were assessed by their carers using the HCL-33-EA.ResultsThe HCL-33-EA showed high internal consistency (Cronbach’s alpha = 0.82) with two factorial dimensions. The Receiver Operating Characteristic (ROC) curve analysis revealed an area under the ROC curve (AUC) value of 0.61 (95% confidence interval (CI): 0.54–0.67). The optimal cut-off score of 7 generated the best combination of sensitivity (0.81) and specificity (0.37) for discriminating between adolescents with BD and MDD.ConclusionThe HCL-33-EA, with a two-factor structure, seems to be a useful tool for screening for BD in depressed adolescents. However, the high sensitivity and low specificity of the HCL-33-EA at the optimal cut-off value of 7 indicate that the HCL-33-EA needs to be further refined for young patients.

Intrapartum ultrasound measurement of the lower uterine segment thickness in parturients with previous scar in labor: a cross-sectional study

BackgroundThere is a lack of reliable methods to estimate the risk of uterine rupture or dehiscence during a trial of labor in women with previous cesarean sections. This study aimed to assess the lower uterine segment and myometrial thickness by ultrasonography in women with previous cesarean sections during labor and assess their association with the uterine defect.MethodsA cross-sectional study was conducted on 161 women in the active phase of labor having one previous cesarean section. The study was conducted et al.-Azhar University Hospital, Assiut City, Egypt, from March 2018 to March 2019. Ultrasound measurements of lower uterine segment thickness and myometrial thickness were conducted by vaginal and abdominal ultrasound by two observers. The correlation of both thicknesses with the uterine defect was analyzed.ResultsUterine defects were reported in 42 women (25.9%), uterine rupture in four women (2.5%), and dehiscence in 38 women (23.5%). The uterine defects were not associated with maternal factors (maternal age, gestational age at labor, body mass index, birth weight, interpregnancy, and inter-delivery interval). Receiver operating curve analysis demonstrated that lower uterine segment thickness was linked with uterine defect, with an area under the curve of 60% (95% CI, 51–70%, P = 0.044). Myometrial thickness was also linked to the uterine defect, with an area under the curve of 61% (95% CI, 52–71%, P = 0.025). Full lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm were the cutoff value with the best combination of sensitivity and specificity for the uterine defect. Lower uterine segment thickness (OR = 0.49, 95%CI 0.24–0.96) and myometrial thickness (OR = 0.44, 95%CI 0.20–0.94) were significantly associated with the uterine defect. Lower uterine segment thickness (OR = 0.41, 95%CI 0.22–0.76) and myometrial thickness (OR = 0.33, 95%CI 0.16–0.66) were also significantly associated with cesarean section delivery.ConclusionA lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm during the first stage of labor are associated with a high risk of uterine defects during a labor trial. These measurements during labor can have a practical application in deciding the mode of delivery in women with previous cesarean sections and might reduce uterine rupture.