Efficient Screening Instrument Research Articles

Adapting the Primary Care PTSD Screener for firefighters.

By the nature of their work, first responders are at risk for post-traumatic stress disorder (PTSD). Efficient screening instruments are useful to identify at-risk first responders and connect them to services. The current study aimed to (i) evaluate the diagnostic properties of the Primary Care PTSD for DSM-5 (PC-PTSD-5) scale among firefighters, (ii) explore the use of an adapted PC-PTSD-5 on a five-point Likert-type scale and (iii) examine sensitivity and specificity of the adapted instrument in this population. Pooled data were analysed among firefighters (N = 92) from a treatment-seeking sample (n = 36) and a population health screening sample (n = 56). Participants completed an adapted version of the PC-PTSD-5 and the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5). Receiver operating characteristic curve analyses were performed, referencing PCL-5 cut-off/probable diagnostic threshold scores. The PC-PTSD-5 demonstrated excellent operating characteristics overall. A threshold of 3 was optimal for discriminating probable PTSD using a proxy for the original PC-PTSD-5 (range: 0-5), whereas a score of 9 was identified for the PC-PTSD-5 permutation that allowed for more response variability (range: 0-20). Our preliminary data suggest the PC-PTSD-5 may be a useful tool for brief firefighter screening, with suggested cut-offs that require further replication and expanded investigation.

The Geras Solutions Cognitive Test for Assessing Cognitive Impairment: Normative Data from a Population-Based Cohort

BackgroundThere is a need for the development of accurate, accessible and efficient screening instruments, focused on early-stage detection of neurocognitive disorders. The Geras Solutions cognitive test (GSCT) has showed potential as a digital screening tool for cognitive impairment but normative data are needed.ObjectiveThe aim of this study was to obtain normative data for the GSCT in cognitively healthy patients, investigate the effects of gender and education on test scores as well as examine test-retest reliability.MethodsThe population in this study consisted of 144 cognitively healthy subjects (MMSE>26) all at the age of 70 who were earlier included in the Healthy Aging Initiative Study conducted in Umeå, Sweden. All patients conducted the GSCT and a subset of patients (n=32) completed the test twice in order to establish test-retest reliability.ResultsThe mean GSCT score was 46.0 (±4.5) points. High level of education (>12 years) was associated with a high GSCT score (p = 0.02) while gender was not associated with GSCT outcomes (p = 0.5). GSCT displayed a high correlation between test and retest (r(30) = 0.8, p <0.01).ConclusionThis study provides valuable information regarding normative test-scores on the GSCT for cognitively healthy individuals and indicates education level as the most important predictor of test outcome. Additionally, the GSCT appears to display a good test-retest reliability further strengthening the validity of the test.

Psychometric Properties of the Chinese Version of the Primary Care Post-Traumatic Stress Disorder Screen-5 for Medical Staff Exposed to the COVID-19 Pandemic.

PurposeThe COVID-19 pandemic may increase the development of psychiatric disorders, such as posttraumatic stress disorder (PTSD) among medical staff. A brief validated screening tool is essential for the early diagnosis of PTSD. The purpose of the present study was to evaluate the validation of a Chinese version of the Primary Care-PTSD-5 (C-PC-PTSD-5) and determine an appropriate cutoff score with optimal sensitivity and specificity for medical staff in China during the COVID-19 pandemic.Participants and MethodsAn online cross-sectional survey was conducted on medical staff (n = 1104) from 17 medical institutions in Shanghai. Questionnaires comprising general information, medical-related traumatic event experiences, the PTSD Checklist (PCL-5), and C-PC-PTSD-5 were distributed to participants using the online Questionnaire Star electronic system. Internal consistency, convergent validity, and test–retest reliability were calculated. Receiver operating characteristic (ROC) analysis was performed to determine diagnostic accuracy and the optimal cutoff score of the C-PC-PTSD-5 for medical staff.ResultsWe included 1062 valid questionnaires for the analysis. Data of 838 traumatic experiences were analyzed. Internal consistency of the C-PC-PTSD-5 was satisfied (Cronbach’s α = 0.756). The total score of the C-PC-PTSD-5 showed good test–retest reliability (r = 0.746). We found a strong correlation between the C-PC-PTSD-5 score and PCL-5 total score (r = 0.669, p < 0.001), which indicated good convergent validity. The ROC analysis showed an area under the curve of 0.81 ± 0.016. A cutoff score of 2 provided optimal sensitivity and specificity for the C-PC-PTSD-5 (sensitivity = 0.632, specificity = 0.871, Youden index = 0.503, and overall efficiency = 0.768).ConclusionOur results indicated that the C-PC-PTSD-5 can be employed as a brief and efficient screening instrument for medical staff exposed to the COVID-19 pandemic. A score of 2 was identified as the optimal threshold for probable clinical PTSD symptoms.

Translation and validation of an extended German version of ID Migraine™ as a migraine screening tool

Background and purpose: Diagnosing a patient with headache as a migraineur is critical for state-of-the-art migraine management. Screening tools are imperative means to improve the diagnostic yield in the primary care settings and specialized clinics. This study aims to translate and assess the diagnostic accuracy of a German version of the ID Migraine™ as a widely used and efficient screening instrument. Methods: The Functional Assessment of Chronic Illness Therapy translation methodology was used to translate the original three-item ID Migraine™, including a fourth question for aura, from the English language into the German language. Diagnostic accuracy of the German ID Migraine™ and predictors of false screening results were assessed among patients presenting to a headache outpatient clinic of a tertiary care center in Germany over a 6-month period. Results: The translation procedure yielded a harmonized German ID Migraine™ and its diagnostic accuracy was assessed in 105 patients (80 female, 46.5 ± 17.2 years of age), including 79 patients (75.2%) with migraine. The three-item German ID Migraine™ provides a sensitivity of 99%, specificity of 68%, and positive and negative predictive values of 90% and 95%, respectively, using a cutoff of ≥2. Positive and negative predictive values in a general headache population are estimated to be 74% and 98%, respectively. The aura question identified 18 out of 20 migraineurs with aura. Conclusions: The German ID Migraine™ is an accurate screening tool for migraine even in a challenging population of a specialized outpatient clinic. Its diagnostic accuracy indicates a potential utility for screening in primary health care.

A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study

BackgroundTime and resource efficient mental disorder screening mechanisms are not available to identify the growing number of refugees and other forcibly displaced persons in priority need for mental health care. The aim of this study was to identify efficient screening instruments and mechanisms for the detection of moderate and severe mental disorders in a refugee setting.MethodsLay interviewers applied a screening algorithm to detect individuals with severe distress or mental disorders in randomly selected households in a Palestinian refugee camp in Beirut, Lebanon. The method included household informant and individual level interviews using a Vignettes of Local Terms and Concepts for mental disorders (VOLTAC), individual and household informant portions of the field-test version of the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS) and the WHO Self Reporting Questionnaire (SRQ-20). A subset of participants were then reappraised utilizing the Mini International Neuropsychiatric Interview (MINI), WHO Disability Assessment Schedule II, and the Global Assessment of Functioning. The study constitutes a secondary analysis of interview data from 283 randomly selected households (n = 748 adult residents) who participated in a mental health disorders prevalence study in 2010.ResultsThe 5-item household informant portion of WASSS was the most efficient instrument among those tested. It detected adults with severe mental disorders with 95% sensitivity and 71% specificity (Area Under Curve (AUC) = 0.85) and adults with moderate or severe mental disorder with 85.1% sensitivity and 74.8% specificity (AUC = 0.82). The complete screening algorithm demonstrated 100% sensitivity and 58% specificity.ConclusionsOur results suggest that a two phase, screen-confirm approach is likely a useful strategy to detect incapacitating mental disorders in humanitarian contexts where mental health specialists are scarce, and that in the context of a multi-step screen confirm mechanism, the household informant portion of field-test version of the WASSS may be an efficient screening tool to identify adults in greatest need for mental health care in humanitarian settings.

Can new inflammatory markers improve the diagnosis of acute appendicitis?

The diagnosis of appendicitis is difficult and resource consuming. New inflammatory markers have been proposed for the diagnosis of appendicitis, but their utility in combination with traditional diagnostic variables has not been tested. Our objective is to explore the potential of new inflammatory markers for improving the diagnosis of appendicitis. The diagnostic properties of the six most promising out of 21 new inflammatory markers (interleukin [IL]-6, chemokine ligand [CXCL]-8, chemokine C-C motif ligand [CCL]-2, serum amyloid A [SAA], matrix metalloproteinase [MMP]-9, and myeloperoxidase [MPO]) were compared with traditional diagnostic variables included in the Appendicitis Inflammatory Response (AIR) score (right iliac fossa pain, vomiting, rebound tenderness, guarding, white blood cell [WBC] count, proportion neutrophils, C-reactive protein and body temperature) in 432 patients with suspected appendicitis by uni- and multivariable regression models. Of the new inflammatory variables, SAA, MPO, and MMP9 were the strongest discriminators for all appendicitis (receiver operating characteristics [ROC] 0.71) and SAA was the strongest discriminator for advanced appendicitis (ROC 0.80) compared with defence or rebound tenderness, which were the strongest traditional discriminators for all appendicitis (ROC 0.84) and the WBC count for advanced appendicitis (ROC 0.89). CCL2 was the strongest independent discriminator beside the AIR score variables in a multivariable model. The AIR score had an ROC area of 0.91 and could correctly classify 58.3 % of the patients, with an accuracy of 92.9 %. This was not improved by inclusion of the new inflammatory markers. The conventional diagnostic variables for appendicitis, as combined in the AIR score, is an efficient screening instrument for classifying patients as low-, indeterminate-, or high-risk for appendicitis. The addition of the new inflammatory variables did not improve diagnostic performance further.

Screening for depression in people with epilepsy: Comparative study among Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Hospital Anxiety and Depression Scale Depression Subscale (HADS-D), and Beck Depression Inventory (BDI)

PurposeWe aimed to assess and compare the psychometric properties of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Hospital Anxiety and Depression Scale Depression Subscale (HADS-D), and Beck Depression Inventory (BDI) as screening instruments for depression and suicidality in people with epilepsy. MethodsOne hundred twenty-six people (54% women) diagnosed with epilepsy were recruited and evaluated on their sociodemographic and clinical features. Depression and suicide risk were assessed with a structured psychiatric interview, the Mini International Neuropsychiatric Interview (MINI-Plus), and the performance of NDDI-E, HADS-D, and BDI was evaluated. ResultsThe sensitivity and specificity of BDI for the diagnosis of depression was around 90%; HADS-D and NDDI-E have sensitivity higher than 80%, and specificity was greater than 75%. For identifying suicide risk, the NDDI-E sensitivity was 92.9%, and HADS-D sensitivity was 85.7%, and a reasonable specificity (68%) was observed for both instruments. All instruments showed a negative predictive value of over 90%. Comparisons of the areas under the ROC curve for these instruments were not significantly different regarding depression or moderate/severe risk of suicide. ConclusionAll three instruments evaluated have clinical utility in the screening of depression in people with epilepsy. Both NDDI-E and HADS-D are brief efficient screening instruments to identify depression in people with epilepsy. The BDI is a more robust instrument, but it takes longer to apply, which hampers its use by busy clinicians and by people with cognitive impairment.

Emergency Department Screening for Adolescent Mental Health Disorders: The Who, What, When, Where, Why, and How It Could and Should Be Done

Mental health problems are a significant cause of morbidity and mortality among pediatric populations. Screening for these problems can result in earlier identification and increase treatment and improve outcomes for these children and adolescents. The emergency department (ED) is an ideal site for such screening. Pediatric ED patients are known to be at higher risk for mental health problems. For many, an ED visit is one of the few opportunities to identify and intervene with these children and adolescents. A number of brief, efficient screening instruments have been developed for the ED setting. Screening for mental health problems is both feasible and acceptable to ED patients, parents, and caregivers.

Further Study of the Psychometric Qualities of a Brief Screening Tool for Social Phobia (MINI-SPIN) Applied to Clinical and Nonclinical Samples

The purpose of this study was to further assess the psychometric qualities of the Mini-Social Phobia Inventory (MS) to screen for social anxiety disorder (SAD). The MS and other self- and clinician-rated scales for anxiety and social anxiety were applied in 2,314 university students and in samples of SAD patients (n = 88) and nonpatients (n = 90). The MS revealed adequate discriminative validity, internal consistency (α= 0.49-0.73), convergent validity with the Social Phobia Inventory, Brief Social Phobia Scale, and Self-Statements During Public Speaking Scale and convergent and divergent validity with the Beck Anxiety Inventory. The MS has shown to be a fast and efficient screening instrument for SAD in different cultures and contexts.

Processing speed and working memory underlie academic attainment in very preterm children

AimTo study the impact of specific neuropsychological measures on academic attainment in very preterm (VPT) children.MethodsVPT children (gestational age <31 weeks, N=48) and matched term controls (N=17) aged 9–10 years...

P02-323 - The prevalence of disorders eating in patients with diabetes mellitus

ObjectivesThe aim of this study was to estimate the prevalence of disorders eating among patients with diabetes mellitus.MethodStudies have shown that The Eating Attitudes Test (EAT-26) can be an efficient screening instrument as part of a two-stage screening process in which those who score at or above a cut-off score of 20 are referred for a diagnostic interview. 44 patients with diabetes mellitus (28 women and 16 men) were recruited for this study. Height, current weight, body mass index (BMI) were determined. The EAT- 26 for Eating Disorders was completed. Results were compared with measurements in 32 nondiabetic subjects (22 women and 10 men).Results and conclusionsThe prevalence of disorders eating among patients with diabetes mellitus was 18.18%. Of the 44 patients with diabetes mellitus, 8 scored higher on EAT (average score 32.01, BMI 31.36 kg/m2) than the remaining 36 patients with diabetes mellitus, whose score averaged 14.22 (BMI 26.32 kg/m2). In this study we found significant differences for the recorded parameters between diabetic patients with and without disorders eating. Age were similar in both groups, but BMI were higher, and scored on EAT were higher in diabetic patients with disorders eating. The prevalence of disorders eating among nondiabetic subjects was 6.25%. Two patients with diabetes mellitus develop a clinical eating disorder and needs cognitive-behavioral, interpersonal psychotherapy and pharmacologic treatment. The EAT-26 score at or above of 20 needs expertise in eating disorders, and nutrition.

The suitability of the BSRS‐5 for assessing elderly who have attempted suicide and need to be referred for professional mental health consultation in a metropolitan city, Taiwan

The goals of this study are to (1) investigate the prevalence of necessary referral for professional mental health consultation for elderly people who attempted suicide ("suicide-attempted") in Kaohsiung city, Taiwan during 2006-2007, (2) assess whether the 5-item Brief Symptom Rating Scale (BSRS-5) can be used as an efficient screening instrument for assessing the probability of a second suicide attempt among the elderly, and (3) examine predictors of needing referral among the suicide-attempted. During the study period, 144 suicide-attempted elderly subjects were enrolled. Demographic data, BSRS-5, SAD PERSONS scale, and Medical Outcome Study Short Form-12 (MOS SF-12) data were collected by a trained semi-professional. The prevalence of necessary referrals for the suicide-attempted elderly was estimated, and the salient factors for their referral were evaluated with logistic regression analysis. A total of 109 participants out of the 144 recruited completed the questionnaires, giving a response rate of 75.7%. The prevalence of necessary referrals for professional mental health consultation was 33.9% (37/109). The significant predictors of needing referrals were lower scores for MCS (OR = 0.89; 95% CI = 0.83-0.96), family discord (OR = 3.86; 95% CI = 1.17-12.75), and type of interviewee (OR = 4.97; 95% CI = 1.57-15.74). When the BSRS-5 is used to evaluate the referral of elderly patients who have attempted suicide for a professional mental health consultation, it is best to conduct in-person interviews to ask whether the elderly patient still has any suicidal ideation. In addition, evaluating quality of life and level of family discord may also be crucial for suicide prevention in the elderly.

The five-item Brief-Symptom Rating Scale as a suicide ideation screening instrument for psychiatric inpatients and community residents

BackgroundAn efficient screening instrument which can be used in diverse settings to predict suicide in different populations is vital. The aim of this study was to use the five-item Brief Symptom Rating Scale (BSRS-5) as a screening instrument for the prediction of suicide ideation in psychiatric, community and general medical settings.MethodsFive hundred and one psychiatric, 1,040 community and 969 general medical participants were recruited. The community participants completed a structured telephone interview, and the other two groups completed the self-report BSRS-5 questionnaire.ResultsThe logistic regression analysis showed that the predictors of suicide ideation for the psychiatric group were depression, hostility and inferiority (p < 0.001, p = 0.016, p = 0.011), for the community group, inferiority, hostility and insomnia (p < 0.001, p < 0.001, p = 0.003), and for the general medical group, inferiority, hostility, depression and insomnia (p < 0.001, p = 0.001, p = 0.020, p = 0.008). The structural equation model showed the same symptom domains that predicted suicide ideation for all three groups. The receiver operating characteristic curve using the significant symptom domains from logistic regression showed that for the psychiatric group, the optimal cut-off point was 4/5 for the total of the significant dimensions (positive predictive value [PPV] = 78.01%, negative predictive value [NPV] = 79.05%), for the community group, 7/8 (PPV = 68.75%, NPV = 96.09%), and for the general medical group, 12/13 (PPV = 92.86%, NPV = 88.48%).ConclusionThe BSRS-5 is an efficient tool for the screening of suicide ideation-prone psychiatric inpatients, general medical patients, and community residents. Understanding the discriminative symptom domains for different groups and the relationship between them can help health care professionals in their preventative programs and clinical treatment.

Alcohol and the accident and emergency department: a current review.

Alcohol misuse constitutes a major problem in our modern society and both physical and mental alcohol-related harm result in a large number of Accident and Emergency (A&E) attendances, thus imposing a significant burden on the workload and financial resources of the department. The current management of problem drinking by most A&E departments could be further improved. The introduction of a holistic approach that includes efficient screening instruments and effective brief, anti-alcoholic interventions, for the management of these patients must be considered. This should strengthen the preventive role of A&E departments, and, in the long term, may result in a decrease in the number of cases of alcohol misuse and in alcohol-related attendances.

Problems in the development and validation of questionnaire-based screening instruments for ascertaining cases with symptomatic knee osteoarthritis: the Framingham Study.

To determine if screening for symptomatic knee osteoarthritis (OA) for clinical trials and epidemiologic studies could be satisfactorily done without performing knee radiographs and to develop efficient screening instruments for symptomatic knee OA based on self-reported symptoms and functional limitations. We administered a mailed questionnaire containing many different questions on knee symptoms and functional limitations to 1,921 participants of the Framingham Study who had previously been screened for symptomatic OA with a history and knee radiographs. Recursive partitioning methods (using the Classification and Regression Trees [CART] program) were used to create a set of screening instruments for symptomatic knee OA, which was defined as knee symptoms on most days and radiographic evidence of OA. Three screening instruments were developed to maximize the sensitivity, specificity, and efficiency. The sensitive instrument had 84% sensitivity and 73% specificity. The specific instrument had 46% sensitivity and 94% specificity. The efficient instrument had 56% sensitivity and 85% specificity. Sensitivity was lower and specificity was higher when these instruments were used to screen for radiographic OA. All instruments had higher sensitivity but lower specificity when used for older subjects (age >60) with greater disease prevalence. However, using any of these instruments as a single-step screening mechanism resulted in considerable misclassification. We conclude that none of these instruments has adequate diagnostic test performance to serve as a single-step evaluation of the presence or absence of symptomatic knee OA.

Prediction of Peripheral Fracture Risk by Quantitative Microdensitometry

Background.The purpose of the study was to investigate whether quantitative microdensitometry (QMD) could be used for screening purposes to identify a population with a high risk for peripheral osteoporotic fractures.Methods.In 1984 bone mineral density (BMD) measurements were made on the index finger of 612 women. Repeated BMD measurements were obtained in 1989 in 440 women. Cox proportional hazards models were used to obtain adjusted estimates of the hazard ratio of a fracture according to BMD or bone loss. Receiver operating characteristic curves were constructed and the areas under the curves (AUC) were compared.Results.Thirty-five women experienced peripheral osteoporotic fractures between the first and the second measurement. Women in the three lowest quartiles of bone density were 1.4–1.8 times (diaphyseal site) and 2.4–2.8 times (metaphyseal site) as likely to experience a fracture as those in the highest quartile. Women in the quartile with the highest bone loss had a risk of 6.9 (diaphyseal site) and 7.5 (metaphyseal site) times higher than women in the lowest quartile. The discriminative power of the measurement as a single test was moderate (AUC 63%); two successive measurements, made with an interval of 5 years to measure bone loss, increased the discriminating power (AUC 74%;P< 0.05).Conclusions.Phalangeal BMD and bone loss, as measured by QMD, are important risk factors for peripheral osteoporotic fractures, but cannot be used as an efficient screening instrument for selecting women with the highest fracture risk.

Screening for abnormal eating attitudes and psychiatric morbidity in an unselected population of 15-year-old schoolgirls.

The Eating Attitudes Test (EAT) and General Health Questionnaire (GHQ) have been validated in an unselected population of 15-year-old South London schoolgirls. Scores on the questionnaires were compared with the results of standard interview. The EAT was found to be an efficient screening instrument for abnormal eating attitudes and behaviour, whereas the GHQ was less satisfactory in its ability to screen for psychiatric morbidity in this age group than in adults. At the optimal cutting points, 6.9% of this population gave a positive response to the EAT and 19.3% gave a positive response to the GHQ. There was a statistically significant positive correlation between the two sets of scores. Compared with their peers, girls giving a positive response to the EAT also reported that they missed more meals during the day and that their weight was more unstable.

52 CHARACTERISTICS OF THE HOME SCREENING QUESTIONNAIRE (HSQ)

About 50% of children in low socio-economic status (SES) environments have school problems, many of which may be due to factors in the home. The HSQ was developed from the Home Observation for Measurement of the Environment (HOME) to improve the early identification of children who will have school problems. Unlike the HOME, the HSQ requires only 15 to 20 minutes of the parent's time to complete and does not require a home visit. The HSQ was developed for two age groups of children: birth to 3 years (0-3 form), and 3 to 6 years (3-6 form). 868 children (0-3 years) and 497 children (3-6 years) were screened with the HSQ. Of these, 503 in the 0-3 group and 287 in the 3-6 group were also given a HOME. The internal consistency of the HSQ is .73 for the 0-3 form and .80 for the 3-6 form. Test-retest reliability is .62 for the 0-3 form and .86 for the 3-6 form. School performance of siblings of children screened was evaluated to estimate test validity. Of the 191 siblings followed, 55% had school problems. The sensitivity of the HSQ, based on sibling school outcome, was 81% as compared with.61% for the HOME; a non-significant difference. The specificity of the HSQ was, however, significantly lower than the HOME (p <.05). There were no significant differences between the 3-6 HSQ and HOME on measures of sensitivity (81% vs. 79%) or specificity. Results suggest that the HSQ may be an efficient screening instrument of the young child's home environment.

Detecting depressive disorders in drug abusers: A comparison of screening instruments

Previous investigators have reported a high prevalence of depressive symptoms in drug-dependent patients. Given the responsiveness of depressive disorders to both psychological and pharmacological treatments, it is desirable to find an economical, efficient screening instrument to detect depressive disorders in this population. In this study, 6 depression symptom screening scales (Beck Depression Inventory, Hamilton Depression Scale, Raskin Depression Scale, Degree of Illness Rating, Symptom Checklist 90 Overall, and Depression Subscale) based on either clinician interview or patient self report, were compared according to their utility in detecting cases of depression among 64 applicants for treatment at a substance abuse treatment unit of a community mental health center. The criteria for a case of depression were the Research Diagnostic Criteria (RDC) which are specified and operationalized. Cases identified using previously described cutoff scores on the screening scales were compared to rates based on the RDC and sensitivity and specificity were determined. The results showed that: (1) although the sensitivity of the symptom scales was acceptable, ranging from 65–94%, the specificity was less impressive, ranging from 39–61%, and (2) the Beck Depression Inventory, a 13-item patient self report was the most sensitive and specific and is recommended for screeningdrug-dependent populations for depression.