Diagnostic Module Research Articles

NDER: A Novel Web Application for Teaching Histology to Medical Students

Medical students require a strong foundation in normal histology. However, current trends in medical school curricula have diminished time devoted to histology. Thus, there is a need for more efficient methods of teaching histology. We have developed a novel software program (Novel Diagnostic Educational Resource; https://pcs-webtest0.pathology.washington.edu/academics/pattern/) that uses annotated whole slide images to teach normal histology. Whole slide images of a wide variety of tissues were annotated by a trainee and validated by an experienced pathologist. Still images were extracted and transferred to the Novel Diagnostic Educational Resource web application. In Novel Diagnostic Educational Resource, an image was displayed briefly and the user was forced to identify the tissue type. The display time changed inversely based on cumulative accuracy to challenge the user and maintain engagement. A total of 129 second-year medical students completed the 30-minute Novel Diagnostic Educational Resource module. Surveys showed an increase in confidence from premodule (0% extremely confident, 4% very, 47% somewhat, and 49% not) to postmodule (9% extremely confident, 57% very, 32% somewhat, and 2% not), P < .0001. Accuracy increased from 72.6% pretest to 95.7% posttest, P < .002. The effect size (Cohen d = 2.30) was very large, where 0.2 is a small effect, 0.5 moderate, and 0.8 large. Ninety-six percent of students would recommend Novel Diagnostic Educational Resource to other medical students, and 98% would use Novel Diagnostic Educational Resource to further enhance their histology knowledge. Novel Diagnostic Educational Resource drastically improved medical student accuracy in classifying normal histology and improved confidence. Additional study is needed to determine knowledge retention, but Novel Diagnostic Educational Resource has great potential for efficient teaching of histology given the curriculum time constraints in medical education.

ИНТЕГРАЦИЯ ФРАКТАЛЬНЫХ И НЕЙРОСЕТЕВЫХ ТЕХНОЛОГИЙ В ПЕДАГОГИЧЕСКОМ КОНТРОЛЕ И ОЦЕНКЕ ЗНАНИЙ ОБУЧАЕМЫХ

The possibility of statement and solution of the problem of searching of theoretical justification and development of efficient didactic mechanisms of the organization of process of pedagogical monitoring and assessment of level of knowledge of trainees can be based on convergence of the leading psychological and pedagogical, mathematical, and informational technologies with accounting of the modern achievements in science. In the article, the pedagogical expediency of realization of opportunities of means of informational technologies in monitoring and assessment of the composite mathematical knowledge, in the management of cognitive activity of students is proved. The ability to integrate fractal methods and neural network technologies in perfecting of a system of pedagogical monitoring of mathematical knowledge of trainees as a part of the automated training systems (ATS) is investigated and realized in practice. It is proved that fractal methods increase the accuracy and depth of estimation of the level of proficiency of students and also complexes of intellectual operations of the integrative qualities allowing to master and apply cross-disciplinary knowledge and abilities in professional activity. Neural network technologies solve a problem of realization of the personal focused tutoring from positions of optimum individualization of mathematical education and self-realization of the person. The technology of projection of integrative system of pedagogical monitoring of knowledge of students includes the following stages: establishment of the required tutoring parameters; definition and preparation of input data for realization of integration of fractal and neural network technologies; development of the diagnostic module as a part of the block of an artificial intelligence of ATS, filling of the databases structured by system; start of system for obtaining the forecast. In development of the integrative automated system of pedagogical monitoring of knowledge the fact that individual evaluation test of tutoring of students is carried out on the basis of two parameters depths of assimilation of a concept, its interrelation with other concepts and assessment of size of the synergetic effect of integration of knowledge and activity of trainees is new. Experience of introduction and operation of the automated system of pedagogical monitoring and assessment of the level of knowledge on the basis of integration of fractal model operation and neural network technologies allowed to increase the level of objectivity of estimation of trainees, quality of management of the educational process, its effectiveness in general.

Rationale method of prior diagnostic modules development of technical support modular prospective hardware for special communications means

Rationale method of prior diagnostic modules development of technical support modular prospective hardware for special communications means

Concurrent Validity of Caffeine Problems and Diagnostic Criteria for Substance Use Disorders.

Background: The DSM-5 proposes caffeine use disorder (CUD) as a condition for further study. The objective of this study was to report on the prevalence of CUD and rates of endorsement for each substance use disorder (SUD) criterion in relation to caffeine compared to alcohol and marijuana in a sample of adolescents presenting for medical care in the primary, adolescent, and substance use clinics at an academic medical center. Methods: A convenience sample of patients (N = 213; 66.7% female) aged 12-17 presenting for medical care completed the Composite Diagnostic Interview-Substance Abuse Module questionnaire, with questions regarding use of caffeine, alcohol, and marijuana. Descriptive analyses were used to determine prevalence of CUD and frequency of each endorsed SUD criterion as applied to caffeine versus alcohol or marijuana. Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) were used to determine psychometric properties for CUD. Results: The majority of subjects (N = 153) reported past 30-day caffeine use and of these, six (4%) met criteria for CUD. All six also met criteria for either alcohol and/or marijuana use disorders. Of the three essential CUD criteria (failure to quit, use despite harm, and withdrawal), both harm and withdrawal were endorsed significantly more often in relation to caffeine versus alcohol. Descriptive fit indices for the CUD model were excellent (CFI = 0.994, TLI = 0.991). Conclusions: In our sample, the proportion of adolescents that met proposed CUD criteria was low, suggesting that the proposed criteria would not lead to overdiagnosis of CUD. CUD was highly correlated with other SUDs.

Sonographic Evaluation of Solitary Thyroid Nodule with Pathologic Correlation

Thyroid nodules are most common problems encountered in clinical practice. There should be proper diagnostic work up to select patients for surgical intervention, who have high chances of harbouring malignancy in the nodule. Ultrasound plays major role in differentiating benign and malignant nodule. Present study is undertaken to identify the various imaging features in thyroid nodules that are associated with benignity and malignancy. To know sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography as diagnostic module for solitary thyroid nodules. Materials and Methods: Present study included 60 patients with solitary thyroid nodule. Transverse and longitudinal real time ultrasound imaging of thyroid gland were performed. Ultrasound appearances of size, shape echogenicity, internal architecture, margins, halo, vascularity, presence or absence of lymph nodes were observed. On the basis of which nodule was classified in to benign or malignant /suspicious for malignancy. Pathological reports were considered standard for comparison. Diagnostic value of ultrasonography was calculated by sensitivity specificity, positive predictive value and negative predictive value. Result and discussion: 60 thyroid nodules were evaluated, with Male: Female ratio of1:5.6. Age of patients ranged from 18 to 63 years with mean age of 36+8.2 years. Sensitivity, specificity, PPV and NPV of ultrasonography as diagnostic tool are 70.0%, 98%, 87.5%, 96% respectively. These statistics correlate well with previous studies. Conclusion: Ultrasound is a sensitive and specific modality in assessment of thyroid nodules with good overall

Electrostatic particle-in-cell simulation of heat flux mitigation using magnetic fields

The particle-in-cell (PIC) method was used to simulate heat flux mitigation experiments with partially ionised argon. The experiments demonstrate the possibility of reducing heat flux towards a target using magnetic fields. Modelling using the PIC method is able to reproduce the heat flux mitigation qualitatively. This is driven by modified electron transport. Electrons are magnetised and react directly to the external magnetic field. In addition, an increase of radial turbulent transport is also needed to explain the experimental observations in the model. Close to the target an increase of electron density is created. Due to quasi-neutrality, ions follow the electrons. Charge exchange collisions couple the dynamics of the neutrals to the ions and reduce the flow velocity of neutrals by radial momentum transport and subsequent losses. By this, the dominant heat-transport channel by neutrals gets reduced and a reduction of the heat deposition, similar to the experiment, is observed. Using the simulation a diagnostic module for optical emission is developed and its results are compared with spectroscopic measurements and photos from the experiment. The results of this study are in good agreement with the experiment. Experimental observations such as a shrank bright emission region close to the nozzle exit, an additional emission in front of the target and an overall change in colour to red are reproduced by the simulation.

Synthetic plasma edge diagnostics for EMC3-EIRENE, highlighted for Wendelstein 7-X.

Interpretation of spectroscopic measurements in the edge region of high-temperature plasmas can be a challenge since line of sight integration effects make direct interpretation in terms of quantitative, local emission strengths often impossible. The EMC3-EIRENE code-a 3D fluid edge plasma and kinetic neutral gas transport code-is a suitable tool for full 3D reconstruction of such signals. A versatile synthetic diagnostic module has been developed recently which allows the realistic 3D setup of various plasma edge diagnostics to be captured. We highlight these capabilities with two examples for Wendelstein 7-X (W7-X): a visible camera for the analysis of recycling, and a coherent-imaging system for velocity measurements.

Synthetic diagnostics platform for fusion plasmas (invited).

A Synthetic Diagnostics Platform (SDP) for fusion plasmas has been developed which provides state of the art synthetic reflectometry, beam emission spectroscopy, and Electron Cyclotron Emission (ECE) diagnostics. Interfaces to the plasma simulation codes GTC, XGC-1, GTS, and M3D-C1 are provided, enabling detailed validation of these codes. In this paper, we give an overview of SDP's capabilities, and introduce the synthetic diagnostic modules. A recently developed synthetic ECE Imaging module which self-consistently includes refraction, diffraction, emission, and absorption effects is discussed in detail. Its capabilities are demonstrated on two model plasmas. The importance of synthetic diagnostics in validation is shown by applying the SDP to M3D-C1 output and comparing it with measurements from an edge harmonic oscillation mode on DIII-D.

Stability of early risk assessment for autism spectrum disorder in preterm infants.

Stability and change in early autism spectrum disorder risk were examined in a cohort of 99 preterm infants (⩽34 weeks of gestation) using the Autism Observation Scale for Infants at 8 and 12 months and the Autism Diagnostic Observation Schedule-Toddler Module at 18 months. A total of 21 infants were identified at risk by the Autism Observation Scale for Infants at 8 months, and 9 were identified at risk at 12 months, including 4 children who were not previously identified. At 18 months, eight children were identified at risk for autism spectrum disorder using the Autism Diagnostic Observation Schedule-Toddler Module, only half of whom had been identified using the original Autism Observation Scale for Infants cutoffs. Results are discussed in relation to early trajectories of autism spectrum disorder risk among preterm infants as well as identifying social-communication deficiencies associated with the early preterm behavioral phenotype.

Reliability and validity of a semi-structured DSM-based diagnostic interview module for the assessment of Attention Deficit Hyperactivity Disorder in adult psychiatric outpatients

Despite growing recognition that the symptoms and functional impairments of Attention Deficit/Hyperactivity Disorder (ADHD) persist into adulthood, only a few psychometrically sound diagnostic measures have been developed for the assessment of ADHD in adults, and none have been validated for use in a broad treatment-seeking psychiatric sample. The current study presents the reliability and validity of a semi-structured DSM-based diagnostic interview module for ADHD, which was administered to 1194 adults presenting to an outpatient psychiatric practice. The module showed excellent internal consistency and interrater reliability, good convergent and discriminant validity (as indexed by relatively high correlations with self-report measures of ADHD and ADHD-related constructs and little or no correlation with other, non-ADHD symptom domains), and good construct validity (as indexed by significantly higher rates of psychosocial impairment and self-reported family history of ADHD in individuals who meet criteria for an ADHD diagnosis). This instrument is thus a reliable and valid diagnostic tool for the detection of ADHD in adults presenting for psychiatric evaluation and treatment.

Understanding One's Own Emotions in Cognitively-Able Preadolescents with Autism Spectrum Disorder.

There are still no straightforward answers as to whether understanding one's own emotions is impaired in autism spectrum disorder (ASD). This study evaluated the perception of one's own different emotions, based on the relevant section of the Autism Diagnostic Observation Schedule Module 3 test. Forty boys, aged 8-11years, 20 diagnosed with ASD (IQ≥85) and 20 typically developing children were included. Description of events that elicited specific emotions in ASD was characterized by more 'odd' statements and 'no responses' and less use of content related to 'social situations', 'interpersonal' and 'self-awareness'. More 'no responses' and odd statements were associated with the severity of ASD symptoms. Clinicians should be aware of these differentiating factors during the diagnostic process of ASD.

Particle filter based hybrid prognostics for health monitoring of uncertain systems in bond graph framework

The paper’s main objective is to address the problem of health monitoring of system parameters in Bond Graph (BG) modeling framework, by exploiting its structural and causal properties. The system in feedback control loop is considered uncertain globally. Parametric uncertainty is modeled in interval form. The system parameter is undergoing degradation (prognostic candidate) and its degradation model is assumed to be known a priori. The detection of degradation commencement is done in a passive manner which involves interval valued robust adaptive thresholds over the nominal part of the uncertain BG-derived interval valued analytical redundancy relations (I-ARRs). The latter forms an efficient diagnostic module. The prognostics problem is cast as joint state-parameter estimation problem, a hybrid prognostic approach, wherein the fault model is constructed by considering the statistical degradation model of the system parameter (prognostic candidate). The observation equation is constructed from nominal part of the I-ARR. Using particle filter (PF) algorithms; the estimation of state of health (state of prognostic candidate) and associated hidden time-varying degradation progression parameters is achieved in probabilistic terms. A simplified variance adaptation scheme is proposed. Associated uncertainties which arise out of noisy measurements, parametric degradation process, environmental conditions etc. are effectively managed by PF. This allows the production of effective predictions of the remaining useful life of the prognostic candidate with suitable confidence bounds. The effectiveness of the novel methodology is demonstrated through simulations and experiments on a mechatronic system.

Seasonal variation in major depressive episode prevalence in Canada.

The purpose of this paper is to describe variation, over the months of the year, in major depressive episode (MDE) prevalence. This is an important aspect of the epidemiological description of MDE, and one that has received surprisingly little attention in the literature. Evidence of seasonal variation in MDE prevalence has been weak and contradictory. Most studies have sought to estimate the prevalence of seasonal affective disorder using cut-points applied to scales assessing mood seasonality rather than MDE. This approach does not align with modern classification in which seasonal depression is a diagnostic subtype of major depression rather than a distinct category. Also, some studies may have lacked power to detect seasonal differences. We addressed these limitations by examining the month-specific occurrence of conventionally defined MDE and by pooling data from large epidemiological surveys to enhance precision in the analysis. Data from two national survey programmes (the National Population Health Survey and the Canadian Community Health Survey) were used, providing ten datasets collected between 1996 and 2013, together including over 500,000. These studies assessed MDE using a short form version of the Composite International Diagnostic Interview (CIDI) for major depression, with one exception being a 2012 survey that used a non-abbreviated version of the CIDI. The proportion of episodes occurring in each month was evaluated using items from the diagnostic modules and statistical methods addressing complex design features of these trials. Overall month-specific pooled estimates and associated confidence intervals were estimated using random effects meta-analysis and a gradient was assessed using a meta-regression model that included a quadratic term. There was considerable sampling variability when the month-specific proportions were estimated from individual survey datasets. However, across the various datasets, there was sufficient homogeneity to justify the pooling of these estimated proportions, producing large gains in precision. Seasonal variation was clearly evident in the pooled data. The highest proportion of episodes occurred in December, January and February and the lowest proportions occurred in June, July and August. The proportion of respondents reporting MDE in January was 70% higher than August, suggesting an association with implications for health policy. The pattern persisted with stratification for age group, sex and latitude. Seasonal effects in MDE may have been obscured by small sample sizes in prior studies. In Canada, MDE has clear seasonal variation, yet this is not addressed in the planning of services. These results suggest that availability of depression treatment should be higher in the winter than the summer months.

Development of a fuzzy-driven system for ovarian tumor diagnosis

In this paper we present OvaExpert, an intelligent system for ovarian tumor diagnosis. We give an overview of its features and main design assumptions. As a theoretical framework the system uses fuzzy set theory and other soft computing techniques. This makes it possible to handle uncertainty and incompleteness of the data, which is a unique feature of the developed system. The main advantage of OvaExpert is its modular architecture which allows seamless extension of system capabilities. Three diagnostic modules are described, along with examples. The first module is based on aggregation of existing prognostic models for ovarian tumor. The second presents the novel concept of an Interval-Valued Fuzzy Classifier which is able to operate under data incompleteness and uncertainty. The third approach draws from cardinality theory of fuzzy sets and IVFSs and leads to a bipolar result that supports or rejects certain diagnoses.

Chronic Wound Characterization using Bayesian Classifier under Telemedicine Framework

Chronic wound (CW) treatment by large is a burden for the government and society due to its high cost and time consuming treatment. It becomes more serious for the old age patient with the lack of moving flexibility. Proper wound recovery management is needed to resolve this problem. Careful and accurate documentation is required for identifying the patient's improvement and or deterioration timely for early diagnostic purposes. This paper discusses the comprehensive wound diagnostic method using three important modules, viz. Wounds Data Acquisition (WDA) module, Tele-Wound Technology Network (TWTN) module and Wound Screening and Diagnostic (WSD) module. Here the wound image characterization and diagnosis tool has been proposed under telemedicine to classify the percentage wise wound tissue based on the color variation over regular intervals for providing a prognostic treatment with better degree of accuracy. The Bayesian classifier based wound characterization (BWC) technique is proposed that able to identify wounded tissue and correctly predict the wound status with a good degree of accuracy. Results show that BWC technique provides very good accuracy, i.e. 87.40%, whereas the individual tissue wise accuracy for granulation tissue is 89.44%, slough tissue is 81.87% and for necrotic tissue is 90.91%.

Development and Preliminary Usability and Accuracy Testing of the EBMT Gvhd App to Support Graft Versus Host Disease Diagnosis and Scoring According to NIH Criteria, By the EBMT Complications and Quality of Life Working Party

Introduction: Accurate diagnosis and severity scoring of acute and, in particular, chronic GVHD remains a challenge for clinical practice and for correct self-reporting of GVHD data to evaluate transplant outcomes. Perceived complexity and time investment issues limit the implementation of international standards and the recently updated NIH criteria for chronic GVHD. Here, we describe the development of the EBMT GVHD App, a computer/web-based algorithm-driven application to help physicians correctly diagnose and score severity of acute and chronic GVHD and improve the implementation of current standards in clinical practice and research.Methods: We applied a User Centered Design (UCD) process, through an iterative process between end-users and the development team to ensure that the App is user-friendly and efficient. A first EBMT GVHD App version (v0.0) tested an initial GVHD algorithm. An second improved prototype v1.0 was developed as a true web application (App) compatible with desktop computers and smartphones/tablets. V1.0 relies on two modules: a diagnostic module for NIH diagnostic, distinctive, common signs or proven evidence of GVHD (skin, nails, scalp/body hair, mouth, eyes, genitals, gastrointestinal tract, liver, lungs and muscles/joints), and a scoring moduleto assess severity of acute (Glucksberg and IBMTR criteria), chronic and overlap (NIH criteria) GVHD. The App v1.0 was tested by 28 hematology professionals (University Hospitals of Leuven, Belgium): 8 senior physicians, 8 junior physicians, 2 medical students and 10 data managers/research nurses; median experience in hematology 2.25 years, range 0-30, IQR 6.6, evenly distributed, by profession and seniority, to one of two groups (A and B).Usability of the App was determined for user experience and satisfaction. User experience was tested at baseline and end of study with the technology acceptance model (TAM), evaluating six Perceived Usefulness Statements rated on a 7-point Likert-like scale (1=extremely unlikely to 7=extremely likely). User satisfaction was evaluated by PSSUQ (Post-Study System Usability Questionnaire), which scores system usefulness, information quality and interface quality, on a 7-point Likert-like scale (1=strongly agree to 7=strongly disagree). App's accuracy relied on the proportion of correctly assessed clinical scenarios from 4 representative GVHD cases developed by a panel of GVHD experts as gold standard. In a quasi-experimental crossover design, professionals were invited to solve two cases either with standard paper tools or with the App, and later crossed over to use the other tool, both for the two other cases, as well as to solve again with the new tool their previous two cases. Comparisons were performed 'within groups' and 'between groups' (A vs B).Results: User experience and satisfaction were very good, with a median of 6 TAM points for user experience, and a median overall PSSUQ score of 2.2 for user satisfaction, 2.1 for System Use, 2.4 for Information Quality and 1.7 for Interface Quality. Users (70%) reported that they would be more likely to use the App on a desktop than on a mobile device.Accuracy results were only moderate with standard paper tools: 65% for diagnosis and 45% for scoring. The use of the App significantly increased diagnostic and scoring accuracy to 94% (+29%) and 88% (+43%), respectively (both p<0.001). The App also improved accuracy of individuals repeating the same clinical case (within groups) for diagnosis (+27%) and scoring (+42%), beyond a potential learning effect.From v1.0 results, an App v2.0 has been developed refining details in the algorithm, improving term description, adding a user's manual and the option of generating patient reports, which is now ready for further testing.Conclusions: The "EBMT GVHD App" is a first electronic tool to diagnose and score GVHD. Initial testing of v1.0 uniformly showed high scores for user experience and satisfaction, accurately reflected the subtle nuances of the NIH criteria, and improved significantly the accuracy of a diverse group of hematology professionals to diagnose and score severity of GVHD, compared to their practice with standard tools. Testing of v2.0 is underway to adapt layout and screen content and to address ambiguities of current guidelines. A larger study with a subsequent v3.0 is warranted in real life setting to evaluate macroscopic scalability. DisclosuresLee:Kadmon: Consultancy; Bristol-Myers Squibb: Consultancy.

Final design of the generic upper port plug structure for ITER diagnostic systems

The generic upper port plug (GUPP) structure in ITER is a 6m long metal box which deploys diagnostic components into the vacuum vessel. This structure is commonly used for all the diagnostic upper ports. The final design of the GUPP structure, which has successfully passed the final design review in 2013, is described here.The diagnostic port plug is cantilevered to the vacuum vessel with a heavy payload at the front, so called the diagnostic first wall (DFW) and the diagnostic shield module (DSM). Most of electromagnetic (EM) load (∼80%) occurs in DFW/DSM. Therefore, the mounting design to transfer the EM load from DFW/DSM to the GUPP structure is challenging, which should also comply with thermal expansion and tolerance for assembly and manufacturing. Another key design parameter to be considered is the gap between the port plug and the vacuum vessel port. The gap should be large enough to accommodate the remote handling of the heavy port plug (max. 25t), the structural deflection due to external loads and machine assembly tolerance. At the same time, the gap should be minimized to stop the neutron streaming according to the ALARA (as low as reasonably achievable) principle. With these design constraints, the GUPP structure should also provide space for diagnostic integration as much as possible. This requirement has led to the single wall structure having the gun-drilled water channels inside the structure. Furthermore, intensive efforts have been made on the manufacturing study including material selection, manufacturing codes and French regulation related to nuclear equipment and safety.All these main design and manufacturing aspects are discussed in this paper, including requirements, interfaces, loads and structural assessment and maintenance.

Multiphysics Engineering Analysis for ITER Diagnostic First Wall and Shield Module Design*

ITER diagnostic first walls (DFWs) and diagnostic shield modules (DSMs) inside the port plugs (PPs) are designed to protect diagnostic instrument and components from a harsh plasma environment and provide structural support while allowing for diagnostic access to the plasma. The design of DFWs and DSMs are driven by 1) plasma radiation and nuclear heating during normal operation 2) electromagnetic loads during plasma events and associate component structural responses. A multi-physics engineering analysis protocol for the design has been established at Princeton Plasma Physics Laboratory and it was used for the design of ITER DFWs and DSMs. The analyses were performed to address challenging design issues based on resultant stresses and deflections of the DFW-DSM-PP assembly for the main load cases. ITER Structural Design Criteria for In-Vessel Components (SDC-IC) required for design by analysis and three major issues driving the mechanical design of ITER DFWs are discussed. The general guidelines for the DSM design have been established as a result of design parametric studies.

Influence of education and diagnostic modes on glaucoma assessment by optometrists.

To evaluate the influence of different clinical examination techniques, including optic nerve head (ONH) photography, visual field tests, and adjunct imaging on the diagnosis of glaucoma by Australian and New Zealand optometrists. The effect of a short-term, didactic teaching module on these is also explored. Clinical data of 30 patients previously seen at the Centre for Eye Health was collected and compiled into glaucoma diagnostic assessment modules. Each of six modules contained different combinations of clinical examination results and required a classification of the cases as normal, suspicious or glaucoma. A cohort of 54 Australian and New Zealand optometrists were recruited for the study and allocated into two cohorts. The intervention group completed a glaucoma training course prior to the assessment while the control group completed the assessment without additional training. Diagnostic accuracy was compared between modules and optometrist groups. High false negative rates were observed with ONH photography, which were drastically reduced with the addition of visual field, albeit at the cost of increased false positive rates. Addition of adjunct imaging techniques partially compensated for the increase in the false positive rate from the visual field, but had limited effect on false negative rate. Educational intervention resulted in larger improvement in the diagnostic ability when multiple imaging modalities were provided. The study highlighted the importance of combining both structural and functional assessments in glaucoma. Current imaging technology demonstrated limited usefulness for event diagnosis due to the persistent difficulties of defining structural and functional loss in glaucoma, thus highlighting the need for new glaucoma assessment techniques. Short-term didactic teaching programs may only result in limited improvement of glaucoma diagnostic ability in optometrists, and hence, it may need to be combined with long-term and/or non-didactic training components to obtain a greater effect.

Validity and Reliability of the Japanese Version of the Rome III Diagnostic Questionnaire for Irritable Bowel Syndrome and Functional Dyspepsia.

Background/AimsReliable diagnostic instruments for measuring the presence of functional gastrointestinal disorders based on the Rome III criteria have been lacking in Japan. The aims of the present study were to translate and validate the Rome III diagnostic questionnaire which was widely used in Western countries.MethodsThe original version of Rome III diagnostic questionnaire was translated from English into Japanese through 3 independent forward translations, resolution, back translation and reconciliation of the differences. Forty-nine patients with irritable bowel syndrome (IBS), 32 patients with functional dyspepsia (FD) and 56 subjects without any current GI symptoms as controls were recruited from three hospitals located in different regions of Japan and completed the IBS and FD diagnostic modules twice within 14 days. Kappa statistic was used to assess test-retest reliability. The sensitivity and specificity of each diagnostic module for distinguishing IBS or FD patients from controls was tested.ResultsMedian kappa statistics were 0.63 for the translated IBS diagnostic module and 0.68 for the FD module. The sensitivity, specificity, and positive predict value of the IBS module against physician diagnosis was 61.2%, 100%, and 100% and those of the FD module was 53.2%, 98.2%, and 94.4%, respectively. Meanwhile, IBS patients were significantly more likely to report blood in stools compared to controls (18.4% vs 1.8%, P < 0.01).ConclusionsThe IBS and FD diagnostic modules on the Japanese version of the Rome III diagnostic questionnaire are valid and reliable. Further studies are warranted to elucidate the diagnostic utility of the red flag questionnaire.