Changes In Post-test Probability Research Articles

Diagnostic accuracy of the upper limb neurodynamic test 1 using neurodynamic sequencing in diagnosis of carpal tunnel syndrome

BackgroundThe upper limb neurodynamic test 1 is used in the diagnosis of median nerve neuropathies such as carpal tunnel syndrome but its diagnostic validity remains limited. Neurodynamic sequencing has been suggested to increase the specificity of the neurodynamic tests, however, to date, information on the diagnostic accuracy of this variation in neurodynamic testing is required. ObjectivesThe aim of this study was to analyze the diagnostic validity of the local sequence of ULNT1 (LS-ULNT1) (i.e. a sequence that begins at the joint where the problem is (wrist) and progressively moves joints further away from it), in the diagnosis of CTS. A secondary aim was to describe the location of sensory responses to this modified neurodynamic test sequence. DesignA prospective diagnostic accuracy study was designed. MethodNerve conduction studies were used as the gold standard. The LS-ULNT1 was performed in 58 consecutive patients (17 men, 44 women) with suspected CTS. ResultsSensitivity of the LS-ULNT1 was 65.7% (CI 48.0–80.9%) and the specificity was 95.7% (CI 78.1–99.9%). The positive and negative likelihood ratios were >5 and < 0.5, respectively, indicating the ability of the test to generate small but sometimes important changes in post-test probability. ConclusionsThe overall results of this study showed that the LS-ULNT1 could be useful in confirming the diagnosis of CTS. The test demonstrated high specificity and the +LR indicated the ability of the test to generate changes in posttest probability, especially with a positive LS-ULNT1 result.

Concurrent validity of a patient self-administered examination and a clinical examination for femoroacetabular impingement syndrome

ObjectiveTelehealth has been established as a viable option for improved access and timeliness of care. Physician-guided patient self-evaluation may improve the viability of telehealth evaluation; however, there are little data...

Reticulocyte hemoglobin content (CHr) untuk skrining defisiensi besi pada ibu hamil

Reticulocyte hemoglobin content (CHr) for iron deficiency screening in pregnant womenBackground: Anemia in pregnancy is a major public health problem in developing countries. In Indonesia, such anemia is generally caused by nutritional deficiencies, particularly iron deficiency. Iron deficiency screening is needed to prevent the development of iron-deficiency anemia in pregnant women that may affect the health of the mother and fetus.Objective: The study objective was to determine the diagnostic validity of reticulocyte hemoglobin content (CHr) for iron deficiency screening in pregnant women.Method: This research is analytic observational research with a cross-sectional design. The subjects were 73 pregnant women in Bantul district with various gestational ages. CHr was examined with an Advia 120 automatic hematology analyzer. Examination of ferritin as gold standard uses chemiluminescens method with Elecsys 1010 immunology analyzer. Table 2x2 is used to test several CHr values in the CHr range for women of reproductive age of 28.8 - 34.5 pg.Results: Based on ferritin &lt;15 μg / L as a gold standard, 13 pregnant women were suffered from iron deficiency while others were normal.Conclusion: CHr at 30.7 pg cut off has a sensitivity of 92.31%; negative predictive value (NPV) 96.2%; and likelihood ratio (LR) produce conclusive changes in post-test probability. In this cut-off, CHr can be used as an iron deficiency screening test in pregnant women.

Physical examination tests of the shoulder: a systematic review and meta-analysis of diagnostic test performance

BackgroundPhysical examination tests of the shoulder (PETS) are clinical examination maneuvers designed to aid the assessment of shoulder complaints. Despite more than 180 PETS described in the literature, evidence of their validity and usefulness in diagnosing the shoulder is questioned.MethodsThis meta-analysis aims to use diagnostic odds ratio (DOR) to evaluate how much PETS shift overall probability and to rank the test performance of single PETS in order to aid the clinician’s choice of which tests to use. This study adheres to the principles outlined in the Cochrane guidelines and the PRISMA statement. A fixed effect model was used to assess the overall diagnostic validity of PETS by pooling DOR for different PETS with similar biomechanical rationale when possible. Single PETS were assessed and ranked by DOR. Clinical performance was assessed by sensitivity, specificity, accuracy and likelihood ratio.ResultsSix thousand nine-hundred abstracts and 202 full-text articles were assessed for eligibility; 20 articles were eligible and data from 11 articles could be included in the meta-analysis. All PETS for SLAP (superior labral anterior posterior) lesions pooled gave a DOR of 1.38 [1.13, 1.69]. The Supraspinatus test for any full thickness rotator cuff tear obtained the highest DOR of 9.24 (sensitivity was 0.74, specificity 0.77). Compression-Rotation test obtained the highest DOR (6.36) among single PETS for SLAP lesions (sensitivity 0.43, specificity 0.89) and Hawkins test obtained the highest DOR (2.86) for impingement syndrome (sensitivity 0.58, specificity 0.67). No single PETS showed superior clinical test performance.ConclusionsThe clinical performance of single PETS is limited. However, when the different PETS for SLAP lesions were pooled, we found a statistical significant change in post-test probability indicating an overall statistical validity. We suggest that clinicians choose their PETS among those with the highest pooled DOR and to assess validity to their own specific clinical settings, review the inclusion criteria of the included primary studies. We further propose that future studies on the validity of PETS use randomized research designs rather than the accuracy design relying less on well-established gold standard reference tests and efficient treatment options.

Postural Instability in Idiopathic Parkinson’s Disease: Discriminating Fallers from Nonfallers Based on Standardized Clinical Measures

Parkinson's disease (PD) predisposes one to falls, which in turn may lead to serious injury and decreased quality of life. Therefore, it is critical to accurately identify those at risk of falling so that preventive measures may be properly applied. Forty-nine participants (25 retrospectively identified fallers and 24 nonfallers) with a diagnosis of idiopathic PD were included in this study. Each was assessed using three categories of measurement tools: PD-specific scales (modified Hoehn and Yahr [HY] and Unified Parkinson's Disease Rating Scale [UPDRS]), balance-specific scales (Berg Balance Scale [BBS], Sensory Organization Test [SOT], and Activities-Specific Balance Confidence Scale [ABC]), and functional gait scales (Self-Selected Gait Velocity [SSGV], Dynamic Gait Index [DGI]), and a standardized obstacle course. Using discriminant function analysis, the BBS, HY, and UPDRS-Activities of Daily Living subscale (UPDRS-ADL) were found to be the best discriminators of faller or nonfaller group membership. Receiver operating characteristic (ROC) curves were employed to suggest cutoff scores and to determine overall predictability. The area under the ROC curves, and the corresponding cutoff scores were as follows for the highest three clinical tests: UPDRS-ADL (0.888/12.5), UPDRS-Overall (0.879/36.5), and the BBS (0.851/43.5). The odds ratios for the UPDRS-ADL, UPDRS-Overall, and the BBS were 32.8, 26.7, and 48.9, respectively. Using positive likelihood ratios and a pretest probability of 51.0%, the changes in posttest probability were UPDRS-ADL (85.9%), UPDRS-Overall (89.9%), and BBS (94.4%). Results from this study suggest that the UPDRS-ADL, UPDRS-Overall, and the BBS are the best clinical tests for discriminating falls in persons with PD.

Indeterminate Ovarian Mass at US: Incremental Value of Second Imaging Test for Characterization—Meta-Analysis and Bayesian Analysis

To compare value of current diagnostic strategies in assessment of changes in posttest probability of ovarian cancer when menopausal status and combination and sequence of diagnostic imaging tests are considered. Prevalence of ovarian cancer according to menopausal status in women with an ovarian mass and performance of combined gray-scale and Doppler ultrasonography (US), computed tomography (CT), and non-enhanced magnetic resonance (MR) imaging and contrast material-enhanced MR imaging after indeterminate results at gray-scale US were derived from meta-analysis by using MEDLINE database and institutional data. Study was approved by the institutional review board of University Hospital Geneva, Geneva, Switzerland; informed consent was waived. Posttest probability values were computed through Bayesian analysis and Monte Carlo simulation after initial gray-scale US and secondary combined gray-scale and Doppler US, CT, or MR imaging, while dependence of test results among imaging modalities was considered. Changes in posttest probability were compared among imaging modalities with summary receiver operating characteristic curves. Prevalence of ovarian cancer was 8.75% in premenopausal women and 32.40% in postmenopausal women with an ovarian mass. After characterization with initial gray-scale US, posttest probability in pre- and postmenopausal women changed, respectively, to 25% and 63% for indeterminate results and to 2% and 7% for benign results. Subsequent use of combined gray-scale and Doppler US, CT, or MR imaging had significant higher positive and lower negative posttest probability than did use of gray-scale US alone. In women with an indeterminate initial US result, posttest probability decreased after secondary testing with benign results for all imaging modalities to 2% in premenopausal women and to 8%-10% in postmenopausal women. After secondary testing for suspicious lesions, posttest probability increased more after non-enhanced (premenopausal women, 70%; postmenopausal women, 92%) or contrast-enhanced MR imaging (premenopausal women, 80%; postmenopausal women, 95%) than it did after combined gray-scale and Doppler US (premenopausal women, 30%; postmenopausal women, 69%) or CT (premenopausal women, 38%; postmenopausal women, 76%) (P < .001). In women with an indeterminate ovarian mass at gray-scale US, MR imaging results contributed to change in probability of ovarian cancer in both pre- and postmenopausal women more than did CT or combined gray-scale and Doppler US results.