Good Diagnostic Agreement Research Articles

Comparison of vessel-Fractional Flow Reserve (vFFR) and Quantitative Flow Ratio (QFR) using instantaneous wave-Free Ratio (iFR) or Resting Full-cycle Ratio (RFR) as reference

Abstract Background Angiography-based functional assessment remains the state of the art to assess the hemodynamic relevance of intermediate coronary stenoses. In addition to fractional flow reserve (FFR), adenosin free indices like instantaneous wave-free ratio (iFR) or resting full-cycle ratio (RFR) are widely used for the invasive evaluation. Although these methods are widely accepted, they are underused in clinical routine due to costs, their invasive nature, longer procedural times, and lack of availability. Vessel-fractional flow reserve (vFFR) and quantitative flow ratio (QFR) are new software-based methods for the evaluation of coronary-physiology. The aim of this study is to compare vFFR and QFR with the established invasive methods iFR or RFR. Methods We prospectively analyzed 95 Patients in our QFR-Registry vFFR- and QFR-computation was performed three-times by two certified, blinded, and independent experts using the QAngio XA 3D 3.2- and CAAS-software, respectively. Results: 101 main epicardial coronary arteries (52 LAD; 19 LCx; 30 RCA) were analyzed using vFFR, QFR and iFR or RFR. vFFR showed a good correlation with adenosine-free indices in all 3 measurements (AUC 0.883 with r=0.672, p<0.001; AUC 0.841 with r=0.618 p<0.001; AUC 0.840 with r=0.592, p<0.001 respectively). The diagnostic accuracy between the three vFFR-measurements and iFR/RFR was 83%; 81% and 79% respectively. QFR-computations showed a similar correlation with iFR/RFR (AUC 0.899 with r=0.720, p<0.001; AUC 0.919 with r=0.649, p<0.001; AUC 0.930 with r=0.703, p<0.001 respectively) with a diagnostic accuracy 88%, 89% and 88% respectively. The intra- and inter-observer reliability for vFFR (intra: mean difference 0.002±0.0568; inter: 0.024±0.054) and QFR (intra: mean difference 0.018±0.071; inter: 0.016±0.075) analyzed in a Bland-Altman Blot showed a good correlation between virtual assessments and invasive measurements with iFR/RFR. Conclusion The data show a good diagnostic agreement between vFFR and QFR and adenosine free invasive assessments. vFFR and QFR appear reasonable alternative approaches for the evaluation of intermediate stenoses. These data provide the rational to prospectively test for a clinical noninferiority of the non-invasive flow measurements.Diagnostic performance of vFFR/cQFR

The diagnostic agreement of sarcopenic obesity with different definitions in Chinese community-dwelling middle-aged and older adults.

In 2022, the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched a consensus on the diagnostic methods for sarcopenic obesity (SO). The study aimed to identify the prevalence and diagnostic agreement of SO using different diagnostic methods in a cohort of subjects from West China aged at least 50 years old. A large multi-ethnic sample of 4,155 participants from the West China Health and Aging Trend (WCHAT) study was analyzed. SO was defined according to the newly published consensus of the ESPEN/EASO. Furthermore, SO was diagnosed as a combination of sarcopenia and obesity. The criteria established by the Asian Working Group for Sarcopenia 2019 (AWGS2019) were used to define sarcopenia. Obesity was defined by four widely used indicators: percent of body fat (PBF), visceral fat area (VFA), waist circumference (WC), and body mass index (BMI). Cohen's kappa was used to analyze the diagnostic agreement of the above five diagnostic methods. A total of 4,155 participants were part of the study, including 1,499 men (63.76 ± 8.23 years) and 2,656 women (61.61 ± 8.20 years). The prevalence of SO was 0.63-7.22% with different diagnostic methods. The diagnosis agreement of five diagnostic methods was poor-to-good (κ: 0.06-0.67). The consensus by the ESPEN/EASO had the poorest agreement with other methods (κ: 0.06-0.32). AWGS+VFA had the best agreement with AWGS+WC (κ = 0.67), and consensus by the ESPEN/EASO had the best agreement with AWGS+ PBF (κ = 0.32). The prevalence and diagnostic agreement of SO varies considerably between different diagnostic methods. AWGS+WC has the highest diagnostic rate in the diagnosis of SO, whereas AWGS+BMI has the lowest. AWGS+VFA has a relatively good diagnostic agreement with other diagnostic methods, while the consensus of the ESPEN/EASO has a poor diagnostic agreement. AWGS+PBF may be suitable for the alternative diagnosis of the 2022 ESPEN/EASO.

Can internal medicine specialists diagnose functional somatic disorders (FSDs)? Training and comparison with FSD specialists.

Functional somatic disorders (FSD) are a common problem across medical settings and remain challenging to diagnose and treat. Many patients with FSD undergo sequential and unnecessary extensive diagnostic work-up, which is costly for society and stressful for patients. Previous studies have shown that the empirically based FSD diagnostic entities are interrater reliable and stable over time. The aim of this study was to investigate whether internists who have received adequate training and with sufficient time per patient could diagnose FSD. This was a prospective diagnostic accuracy study. The study was conducted from May 2020 to April 2022. The study included 27 consecutive patients referred by their general practitioner to a non-psychiatric diagnostic clinic for assessment of physical symptoms on suspicion of FSD. The internists received a 30-hour training course in the use of a tailored version of the SCAN interview. The main outcome measure was the agreement between the diagnoses of the internists and the reference diagnoses made by specialists in FSD on the basis of the full SCAN interview. The interrater agreement between the internists and the FSD experts was substantial for any FSD (kappa = 0.63) as well as multi-organ vs. single-organ FSD (kappa = 0.73), indicating good diagnostic agreement. Internists with proper training and sufficient time (3-4 hours) per patient can proficiently diagnose FSD employing a tailored version of the SCAN interview for use in a non-psychiatric diagnostic setting.

Comparison of glass and digital slides for cervical cytopathology screening and interpretation.

Cervical cancer is the second most common form of cancer and a leading cause of premature death among women aged 15 to 44 worldwide. In Brazil, there is a high prevalence of infection by the human papillomavirus - HPV. Digital pathology optimizes time and space for reading cervicovaginal cytology slides. We evaluated the feasibility of using whole slide images (WSI) for the routine interpretation of cytology exams. A total of 99 cases of vaginal cytology were selected from a reference laboratory in Northeastern Brazil. Three cytotechnicians participated in the study. Cellular atypia was the one that most presented concordance values. Two observers almost perfectly agreed (k = 0.86 and k = 0.84, respectively) on the negative diagnoses. The performance of the evaluators for NILM (negative for intraepithelial lesion and malignancy) showed high reproducibility and sensitivity in the digital slides, mainly between evaluators A and C. In contrast, the microbiology group showed disagreement between the diagnoses by digital slides and the standard- gold. The concordance between the digital diagnoses and the gold standard for ASCUS was 89%. In the inflammatory category, Spearman's test showed similar results between raters A, B, and C (rs = 0.47, rs = 0.41, and rs = 0.47, respectively). This study reports the diagnostic validation using digital slides in view of the need to optimize the cytology visualization process. Our experience shows good diagnostic agreement between digital and optical microscopy in several analyzed categories, but mainly in relation to cellular atypia and inflammatory processes.

Efficacy of Children Neuropsychological and Behavioral Scale in Screening for Autism Spectrum Disorders through a Combination of Developmental Surveillance.

This study aimed to explore the clinical value of Children Neuropsychological and Behavioral Scale-Revision 2016 (CNBS-R2016) for Autism Spectrum Disorder (ASD) screening in the presence of developmental surveillance. All participants were evaluated by the CNBS-R2016 and Gesell Developmental Schedules (GDS). Spearman's correlation coefficients and Kappa values were obtained. Taking GDS as a reference assessment, the performance of the CNBS-R2016 for detecting the developmental delays of children with ASD was analyzed with receiver operating characteristic (ROC) curves. The efficacy of the CNBS-R2016 to screen for ASD was explored by comparing Communication Warning Behavior with Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). In total, 150 children aged 12-42 months with ASD were enrolled. The developmental quotients of the CNBS-R2016 were correlated with those of the GDS (r=0.62-0.94). The CNBS-R2016 and GDS had good diagnostic agreement for developmental delays (Kappa=0.73-0.89), except for Fine Motor. There was a significant difference between the proportions of Fine Motor, delays detected by the CNBS-R2016 and GDS (86.0% vs. 77.3%). With GDS as a standard, the areas under the ROC curves of the CNBS-R2016 were above 0.95 for all the domains except Fine Motor, which was 0.70. In addition, the positive rate of ASD was 100.0% and 93.5% when the cut-off points of 7 and 12 in the Communication Warning Behavior subscale were used, respectively. The CNBS-R2016 performed well in developmental assessment and screening for children with ASD, especially by Communication Warning Behaviors subscale. Therefore, the CNBS-R2016 is worthy of clinical application in children with ASD in China.

Development and Evaluation of Recombinase Polymerase Amplification Assay for Diagnosis of Canine Leptospirosis

Background: Canine Leptospirosis is a life-threatening disease and zoonosis. Usually, PCR assay is carried out for early diagnosis but requires a thermal cycler and post-PCR procedures. This limits its use in resource-limited areas. Hence, the isothermal amplification of nucleic acid by recombinase polymerase amplification assay was developed as a versatile alternative for the diagnosis of canine leptospirosis in this study. Methods: The RPA assay to detect Leptospira DNA was optimized with Leptospira reference strains and its performance characteristics such as analytical, diagnostics and reproducibility were assessed. Result: The limit of detection of RPA assay was estimated as 102 copies of genomic DNA and specific to amplify the pathogenic Leptospira. Out of 150 dog samples screened, Leptospira DNA was detected in 64 (42.6%) by RPA assay and 67 (44.6%) by PCR. The diagnostic sensitivity and specificity of the RPA assay were 92.5% and 97.59% respectively. The RPA assay has a good diagnostic agreement with a kappa value of 0.905. The reproducibility assessment with the third-party testing laboratory revealed a better agreement with a kappa value of 0.81. The simplicity, rapid and less expensive enable this assay to perform at resource-limited laboratories or point-of-care testing.

Clinical utility of cerebrospinal fluid biomarkers measured by LUMIPULSE® system.

Cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD) are well-established in research settings, but their use in routine clinical practice remains a largely unexploited potential. Here, we examined the relationship between CSF biomarkers, measured by a fully automated immunoassay platform, and brain β-amyloid (Aβ) deposition status confirmed by amyloid positron emission tomography (PET). One hundred ninety-nine CSF samples from clinically diagnosed AD patients enrolled in a clinical study and who underwent amyloid PET were used for the measurement of CSF biomarkers Aβ 1-40 (Aβ40), Aβ 1-42 (Aβ42), total tau (t-Tau), and phosphorylated tau-181 (p-Tau181) using the LUMIPULSE system. These biomarkers and their combinations were compared to amyloid PET classification (negative or positive) using visual read assessments. Several combinations were also analyzed with a multivariable logistic regression model. Aβ42, t-Tau, and p-Tau181, and the ratios of Aβ42 with other biomarkers had a good diagnostic agreement with amyloid PET imaging. The multivariable logistic regression analysis showed that amyloid PET status was associated with Aβ40 and Aβ42, but other factors, such as MMSE, sex, t-Tau, and p-Tau181, did not significantly add information to the model. CSF biomarkers measured with the LUMIPULSE system showed good agreement with amyloid PET imaging. The ratio of Aβ42 with the other analyzed biomarkers showed a higher correlation with amyloid PET than Aβ42 alone, suggesting that the combinations of biomarkers could be useful in the diagnostic assessment in clinical research and potentially in routine clinical practice.

Comparison of quantitative flow ratio (QFR) and instantaneous wave-free ratio (iFR) or resting full-cycle ratio (RFR) during daily routine in the catheterization laboratory

Abstract Background The prognosis of patients with coronary artery disease (CAD) depends strongly on the hemodynamic relevance of the stenosis. The gold standard is the invasive evaluation of the stenosis using Fractional Flow Reserve (FFR), instantaneous wave-free ratio (iFR) or Resting Full-Cycle Ratio (RFR). The use of invasive procedures remains low due to procedural factors and costs. Quantitative Flow Ratio (QFR) is a novel, software-based method to evaluate the physiology of coronary lesions during cardiac catheterization. Computing a three-dimensional model of the vessel based on two angiographic recordings and analyzing the fluid dynamics of the contrast medium flow, the software computes the FFR. In the setting of clinical studies, it has been demonstrated that QFR is feasible and correlates well with FFR. The aim of this study is to compare feasibility and reliability of QFR with established measurements of the iFR or RFR in daily routine. Methods Patients with an indication for an invasive coronary angiography and a stenosis of 30 to 90% were simultaneously assessed using QFR and iFR/RFR in a routine setting. The QFR-computation was performed online by a certified expert with QAngio XA 3D 3.2. The following outcome parameters were analyzed: time to result, volume of applicated contrast medium, applicated dose area product, result of the evaluation. The results have been registered for both methods, respectively. Results 102 coronary arteries were analyzed using QFR and iFR or RFR. QFR shows a good correlation (r=0.753, AUC=0.922) and accuracy (agreement 89.22%, sensitivity 95.83%, specificity 83.33%, PPV 83.64%, NPV 95.74%). The data show that QFR delivers significantly faster results and reduces the procedure related applicated radiation dose from in median 598.8 cGy cm2 to 306.75 cG ycm2 (p<0.001). The study shows no significant difference regarding the amount of contrast medium used. Conclusion QFR has a good diagnostic agreement and can reduce procedure length and applicated radiation dose. Thereby QFR could increase the use of physiologically guided coronary interventions in daily routine. Funding Acknowledgement Type of funding sources: None.

Identification and predictive analysis for participants at ultra-high risk of psychosis: A comparison of three psychometric diagnostic interviews

BACKGROUNDAn accurate identification of individuals at ultra-high risk (UHR) based on psychometric tools to prospectively identify psychosis as early as possible is required for indicated preventive intervention. The diagnostic comparability of several psychometric tools, including the comprehensive assessment of at risk mental state (CAARMS), the structured interview for psychosis-risk syndrome (SIPS) and the bonn scale for the assessment of basic symptoms (BSABS), is unknown. AIMTo address the psychometric comparability of CAARMS, SIPS and BSABS for subjects who are close relatives of patients with schizophrenia. METHODSIn total, 189 participants aged 18-58 years who were lineal relative by blood and collateral relatives by blood up to the third degree of kinship of patients with schizophrenia were interviewed in the period of May 2017 to January 2019. Relatives of the participants diagnosed schizophrenia were excluded. All the participants were assessed for a UHR state by three psychometric tools (CAARMS, SIPS and BSABS). The psychometric diagnosis results included at risk of psychosis (UHR+), not at risk of psychosis (UHR-) and psychosis. Demographic and clinical characteristics were also measured. The inter-rater agreement was assessed for evaluation of the coherence of the three scales. Transition rates for UHR+ subjects to psychosis within 2 years were also recorded.RESULTSThe overall agreement percentages were 93.12%, 92.06% and 93.65% of CAARMS and SIPS, SIPS and BSABS and CAARMS and BSABS, respectively. The overall agreement percentage of the relative functional impairment of the three groups (UHR+, not at risk of psychosis and psychosis) were 89.24%, 86.36% and 88.12%, respectively. The inter-rater reliability of the CAARMS, SIPS and BSABS total score was 0.90, 0.89 and 0.85. The inter-rater reliability was very good to excellent for all the subscales of these three instruments. For CAARMS, SIPS and BSABS, the kappa coefficient about UHR criteria agreement was 0.87, 0.84 and 0.82, respectively (P < 0.001). The transition rates of UHR+ to psychosis within 2 years were 16.7% (CAARMS), 10.0% (SIPS) and 17.7% (BSABS).CONCLUSIONThere is good diagnostic agreement between the CAARMS, SIPS and BSABS towards identification of UHR participants who are close relatives of patients with schizophrenia.

Diagnostic performance and interreader agreement of CEUS LI-RADS in ≤ 30mm liver nodules with different experienced radiologists.

To explore the diagnostic performance and interreader agreement of CEUS LI-RADS in diagnosing ≤ 30mm liver nodules with different experienced radiologists. Between January 2018 and October 2020, 244 patients at high-risk for HCC who underwent CEUS were enrolled. Two novice radiologists and two expert radiologists independently evaluated LI-RADS categories and main features. Kappa (κ) and Kendall'stests wereemployed to evaluate the interreader agreement of CEUS LI-RADS. The diagnostic performance was determined based on sensitivity, specificity, accuracy, PPV and NPV. The interreader agreement for arterial phase hyperenhancement, late and mild washout, early washout, and rim hyperenhancement was moderate to almost perfect (κ, 0.44-0.93) among the different levels of radiologists. The interreader agreement for the LI-RADS categories was substantial to almost perfect (κ, 0.78-0.88). However, the interreader agreement for marked washout was fair to moderate (κ, 0.28-0.50). When CEUS LR-5 was used as a diagnostic criterion for HCC, there were no statistical differences in sensitivity, specificity, accuracy, PPV and NPV among the radiologists (p > 0.05), except for the differences between Reader 4 and the remaining three radiologists in terms of accuracy and sensitivity (p < 0.05). CEUS LI-RADS has good diagnostic agreement for ≤ 30mm liver nodules among experienced radiologists.

Prevalence and diagnostic agreement of sarcopenic obesity with different definitions among Chinese community-dwelling older adults.

this retrospective study aims to compare the prevalence and diagnostic agreement of sarcopenic obesity (SO) using different obesity diagnostic methods among Chinese community-dwelling older adults. SO was diagnosed with sarcopenia and obesity diagnostic methods. Sarcopenia was defined using the Asian Working Group for Sarcopenia criteria 2019 (AWGS2019). Four widely used indicators were used to define obesity: body mass index (BMI), waist circumference (WC), percent of body fat (PBF) and visceral fat area (VFA). Cohen's kappa was used to analyse the diagnosis agreement of SO between different diagnostic methods. a total of 1,050 participants were included, including 347 men (71.3 ± 7.4years) and 703 women (69.9 ± 7.5years). The prevalence of sarcopenia was 25% in total participants, there was no difference between men (24.2%) and women (25.5%), (P = 0.705). With different obesity diagnostic methods, the obesity prevalence ranged from 4.1 to 42.2%, the SO prevalence was 0.1-7.9%. The diagnosis agreement of SO was poor-to-moderate (κ ranged from -0.002 to 0.682). Among the four diagnostic methods, AWGS combined with BMI had the poorest agreement (κ = -0.002 with other methods), AWGS combined with VFA had the best agreement (κ = 0.641 and 0.682 with AWGS combined with PBF and with AWGS combined with WC, respectively). the prevalence of SO vary considerably and the diagnostic agreement is poor-to-moderate with non-uniform diagnostic methods. BMI has the lowest sensitivity, whereas VFA has the highest sensitivity in diagnosis of SO, and VFA has a relatively good diagnostic agreement with other diagnostic methods.

Comparación entre los criterios diagnósticos del síndrome de intestino irritable en una población latinoamericana. Estudio descriptivo de un centro de atención terciaria

Background and aims. The appropriate diagnosis of irritable bowel syndrome is critical due to its association with impaired quality of life and high health care costs. We aim to explore the proportion of subjects with irritable bowel syndrome by the Rome IV criteria at a tertiary care center and compare them with previous diagnostic criteria. Material and methods. We conducted a cross-sectional descriptive study in a tertiary care center located in Buenos Aires. There were included to the consecutive adult patients who consulted for abdominal disorders and in whom an organic pathology had been excluded. Subjects completed a gastrointestinal symptom questionnaire and the proportion of patients with IBS, according to Roma IV criteria, was compare with the proportion of those who met the previous criteria (Manning, Rome I, II and III). Results. Of 178 patients included, 58% met the diagnosis criteria for IBS using the Rome IV criteria. Of these, 98% were also Rome III positive, 76.7% IBS Rome II positive, 93% IBS Rome I positive and 99% IBS Manning positive. The agreement was very good with Rome III (kappa = 0.87), good with Rome I (kappa = 0.76) and good, but lower with Rome II (kappa = 0.73) and Manning (kappa = 0.66). Conclusions. Good diagnostic agreement was established between Rome IV and the previous IBS criteria, except with Rome II and Manning, which were lower.

Validation of an immunohistochemical assay, CEACAM5 IHC 769, under development for use with the antibody-drug conjugate tusamitamab ravtansine (SAR408701).

e21030 Background: Despite recent advances in non-small cell lung cancer (NSCLC) treatment, a need remains for treatment options at disease progression. Tusamitamab ravtansine (SAR408701) is an antibody-drug conjugate of a humanized CEACAM5-specific monoclonal antibody linked to the maytansinoid DM4, a potent anti-tubulin agent. In a Phase 1/2 study, tusamitamab ravtansine showed promising antitumor activity in pretreated advanced non-squamous NSCLC (NSQ NSCLC) patients with high CEACAM5 expression, defined as ≥ 50% of the tumor cells per specimen with CEACAM5 positive staining at ≥ 2+ intensity (Gazzah A et al. J Clin Oncol 2020;38[15]: 9505). Sanofi and Agilent have partnered to develop an immunohistochemical (IHC) assay, CEACAM5 IHC 769, for detection of CEACAM5 protein in formalin-fixed paraffin-embedded (FFPE) NSQ NSCLC tissue using the EnVision FLEX visualization system on Dako Omnis. This assay is in development for the assessment of patients for whom tusamitamab ravtansine is being considered. Methods: CEACAM5 IHC 769 is a qualitative IHC assay using mouse monoclonal anti-CEACAM5 clone 769. Murine anti-CEACAM5 clone 769 is based on tusamitamab ravtansine, with the same specificity as the drug for CEACAM5. The clone was developed by Sanofi and used to evaluate CEACAM5 expression in a Phase 1/2 trial. The CEACAM5 IHC 769 scoring algorithm defines positive staining as any partial or complete tumor cell plasma membrane staining at ≥ 2+ intensity. Membrane staining may be linear or punctate. Staining may appear as complete or partial staining involving the basal, lateral, or basolateral aspects of the membrane, or as apical staining of the luminal aspect of the cell. CEACAM5 IHC 769 is being validated by Agilent Technologies for NSQ NSCLC at the cutoff of ≥ 50% at ≥ 2+ intensity. Internal studies included sensitivity, specificity, intra-block heterogeneity, observer precision, laboratory repeatability/precision, and robustness. Results: Sensitivity studies demonstrated detection across a dynamic range of CEACAM5 expression. Specificity studies indicated that the antibody is specific for CEACAM5. An intra-block heterogeneity study showed good overall diagnostic agreement for sections from the same tumor (point estimate ≥ 85%). Inter- and intra-observer precision, laboratory repeatability/precision, and robustness validation studies met acceptance criteria; the lower bound of the two-sided 95% confidence interval was ≥ 85% for positive, negative, and overall percent agreement. Conclusions: Internal validation studies demonstrated that CEACAM5 IHC 769 is sensitive, specific, precise, reproducible and robust in evaluating CEACAM5 expression in NSQ NSCLC tissue at the cutoff of ≥ 50% at ≥ 2+ intensity. CEACAM5 IHC 769 is being used for patient selection/stratification in ongoing Phase 2 and 3 clinical trials of tusamitamab ravtansine.

Agreement and diagnostic accuracy of vision screening in preschool children between vision technicians and spot vision screener.

Purpose:Screening preschool children for vision-related disorders poses a challenge. This study is designed to determine the agreement and diagnostic accuracy of the spot vision screener (SVS) in screening preschool children compared to screening procedure by vision technicians (VT).Methods:This study was conducted as a part of the ongoing study titled “Initiative for Screening Children for Refractive Errors and other Eye Health Needs (I-SCREEN).” Children from 33 Anganwadis (preschools) in two districts, Adilabad district of Telangana and Krishna district of Andhra Pradesh, in South India, underwent eye health screening by a VT and by a trained community eye health workers (CEHW) using the SVS. Findings were compared for agreement and diagnostic accuracy of assessment.Results:A total of 976 preschool children were screened by the VT and separately by the CEHW using the SVS in Adilabad (15 schools) and Krishna (18 schools) districts. The overall mean age of these children was 2.5 years (SD ± 1.3 years). There were 48 (4.9%) referrals by VT compared to 105 (10.8%) referrals by CEHW using SVS. The overall sensitivity of SVS was 91.7% (95% CI: 80%–97.7%) and the specificity was 93.4% (95% CI: 91.6%–94.9%). Positive predictive value was 41.9% (95% CI: 32.3%–51.9%) and negative predictive value was 99.5% (95% CI: 98.8%–99.9%) with a moderate agreement (0.54; 95% CI 0.49–0.64) between VT screening and screening with SVS.Conclusion:The SVS showed good diagnostic accuracy and agreement in screening for possible vision-related disorders in preschool children.

Diagnostic performance of angiography-based quantitative flow ratio for the identification of myocardial ischemia as assessed by 13N-ammonia myocardial perfusion imaging positron emission tomography

BackgroundQuantitative flow ratio (QFR) is a novel, adenosine-free method for functional lesion interrogation based on 3-dimensional quantitative coronary angiography and computational algorithms. We sought to investigate the diagnostic performance of QFR versus myocardial perfusion imaging positron emission tomography (MPI-PET), which yields the highest accuracy for detection of myocardial ischemia. MethodsDiagnostic performance of QFR versus MPI-PET was assessed in consecutive patients undergoing both clinically indicated coronary angiography and 13N-ammonia MPI-PET within a six-month period. ResultsOut of 176 patients (439 coronary arteries), 19.3% were women. Percent area stenosis was 45 [32–58] %. Myocardial ischemia on 13N-ammonia MPI-PET was detected in 106 (24.1%) vessel territories and hemodynamic significance defined as contrast-flow vessel QFR ≤ 0.80 was observed in 83 (18.9%) vessels. Diagnostic accuracy, sensitivity, and specificity of contrast-flow vessel QFR for the prediction of myocardial ischemia on 13N-ammonia MPI-PET were 92.5 (95% CI 89.6–94.7) %, 73.6 (95% CI 64.1–81.7) %, and 98.5 (95% CI 96.5–99.5) %, respectively. The AUCs for contrast-flow vessel QFR, percent diameter stenosis, and percent area stenosis were 0.85 (95% CI 0.81–0.88, p < 0.001), 0.76 (95% CI 0.71–0.79, p < 0.001) and 0.75 (95% CI 0.70–0.79, p < 0.001), respectively. ConclusionsQFR, a novel diagnostic tool for functional coronary lesion assessment, provides good diagnostic agreement with MPI-PET and superior diagnostic accuracy for the detection of myocardial ischemia as compared to anatomic indices. Future studies will have to determine the non-inferiority of QFR to fractional flow reserve with respect to clinical outcomes.

Physiotherapists' ability to diagnose and manage shoulder disorders in an outpatient orthopedic clinic: results from a concordance study

Advanced practice physiotherapy has emerged as a promising solution to improve health care access because access to orthopedic care is limited in several countries. However, evidence supporting advanced practice physiotherapy models for the management of shoulder pain remains scarce. The purpose of this study was to establish diagnostic, surgical triage, and medical imaging agreement between advanced practice physiotherapists (APPs) and orthopedic surgeons (OSs) for the management of patients with shoulder disorders in an outpatient orthopedic clinic. Patients referred to an OS for shoulder complaints were recruited and independently assessed by an OS and an APP. Each provider completed a standardized form indicating diagnosis, imaging test requests, and triage of surgical candidates. Patientsatisfaction with care was recorded with the 9-item Visit-Specific Satisfaction Questionnaire (VSQ-9). Inter-rater concordance was calculated with the Cohenκ, prevalence-adjusted bias-adjusted κ, and associated 95% confidence interval (CI). We used χ2 tests to compare differences between providers in terms of treatment planoptions and Student t tests to compare patientsatisfaction between providers. Fifty participants were evaluated. Good diagnostic agreement was observed between providers (κ, 0.80; 95% CI, 0.67-0.93). Agreement for triage of surgical candidates was moderate (κ, 0.46; 95% CI, 0.21-0.71) as APPs tended to refer patients more often to OSs for further evaluation. Imaging testrequest agreement was moderate as well (κ, 0.42; 95% CI, 0.19-0.66). Patientsatisfaction with care was high, with no significant differences found between providers (P = .70). APPs could improve access to orthopedic care for shoulder disorders by safely initiating patient care without compromising satisfaction. These results support further development and evaluation of APP care for orthopedic patients presenting with shoulder disorders.

Physician and behavioral health provider diagnostic agreement in a general hospital setting.

Behavioral health providers are often employed in inpatient settings. However, it is unclear if there is mental health diagnosis agreement between referring physicians and behavioral health providers. The purpose of this study is to assess for referring physician and behavioral health provider mental health diagnostic agreement in a general hospital setting. An analysis of 60 consecutive inpatient referrals to a behavioral health provider in a general hospital setting was conducted. The initial referral diagnosis from referring internal medicine physicians was compared with the diagnosis made by the behavioral health provider. Kappa statistics indicated good diagnostic agreement for substance abuse (.79), anxiety disorders (.82), adjustment disorders (.88), relational conflict (.88), and "other" (.74). There was less agreement for depressive disorders (.55). Diagnostic agreement was good overall, suggesting that referrals to inpatient behavioral health providers are often appropriate. Results indicated that depression was underdiagnosed by physicians in the study sample. This is problematic given that depression can be successfully treated through the use of medication and psychotherapy.

Validity of Diagnostic Criteria for Temporomandibular Joint Disorder in the Diagnosis of Disc Displacement Disorders of Temporomandibular Joint.

Objective:The objective of this study is to assess the validity Diagnostic Criteria for Temporomandibular joint Disorder (DC/TMD) in the diagnosis of disc displacement (DD) disorders of temporomandibular joint (TMJ).Study Design:It was a prospective study in which total of 55 patients accounting to 110 TMJ; with clinical diagnosis of DD disorder as per DC/TMD criteria and all above age of 18 years were included. All the patients with clinical diagnosis of DD disorder were advised MRI. All the MRI scans were read by single radiologist. Clinician and Radiologist were blinded to each others findings. MRI diagnosis and clinical diagnosis were compared and results were formulated.Results:The use of the Kappa statistic test indicated a good diagnostic agreement (k = 0.68) between the clinician and the radiologist. The DC/TMD criterion was found to have good validity and reliability in the diagnosis of DD disorders with sensitivity of 91.57% and specificity of 77.78%. The positive predictive value and negative predicted value calculated were 92.68% and 78%, respectively. The positive and negative likelihood ratio found was 4.12 and 0.11, respectively.Conclusion:DC/TMD is a simple, reliable, valid, cost-effective tool in the diagnosis of DD disorders.

The Diagnosis Performance of the TCM Syndromes of Irritable Bowel Syndrome by Gastroenterologists Based on Modified Simple Criteria Compared to TCM Practitioners: A Prospective, Multicenter Preliminary Study.

Purpose Traditional Chinese medicine (TCM) including Chinese patent medicine has been widely used to treat irritable bowel syndrome (IBS). Syndrome differentiation is the essence of TCM. However, the diagnostic ability of gastroenterologists to detect TCM syndromes in IBS in China remains unknown. The aim of this study was to investigate the ability of gastroenterologists to diagnose the TCM syndromes of IBS based on modified simple criteria compared with TCM practitioners. Methods Patients meeting the Rome III criteria for IBS-D or IBS-C were recruited from six tertiary referral centers between January 2016 and December 2017. After learning the diagnosis criteria of the TCM syndromes in IBS, gastroenterologists first diagnosed the syndromes of the enrolled patients. Subsequently, the patients were diagnosed by TCM practitioners. The rate of agreement between the gastroenterologists and TCM practitioners was analyzed. In addition, demographic data and the distribution of TCM syndrome types in IBS were also analyzed. Results A total of 178 patients (93 males and 85 females), including 131 patients with IBS-D and 47 patients with IBS-C, were enrolled in this study. The rate of agreement of the syndrome diagnosis between the gastroenterologists and TCM practitioners was 84.3%. The diagnosis consistency rates among IBS-D patients and IBS-C patients were 87.0% and 76.5%, respectively. The most common TCM syndrome type in IBS-D patients was liver depression and spleen deficiency syndrome (27.5%), followed by spleen-yang deficiency syndrome (19.8%). Dryness and heat in intestine syndrome was the most common TCM syndrome in IBS-C patients (57.4%). Conclusions Gastroenterologists had good diagnostic agreement with TCM practitioners for diagnosing TCM syndrome types in IBS after learning the diagnostic criteria. This knowledge can aid gastroenterologists in selecting suitable Chinese patent medicine to treat IBS.

A comparative study to evaluate diagnostic agreement of IMNCI algorithm in young infants

Background: Under-five and infant mortality constitutes a major health problem in India. To combat this high mortality, IMCI strategy aiming at holistic and integrated approach to child health and development was developed by WHO. Methods: This study is a comparative study conducted at Emergency and Outpatient Department of Pediatrics FHMC Tundla and SNMC Agra. Total of 200 young infants(0-2months) were taken. Detailed history and examination was done for all enrolled young infants according to IMNCI and for enrolled infants diagnosis and treatment was made in the Pediatric Department and was considered as Gold Standard. Results: Out of total 200 young infants, 117 were 0-7 days of age and rest 83 were 7- 59 days of age. Of these 109 infants were admitted, and 91 infants were sent home after initial management. There was no mismatch in diagnosis of 48% infants, while partial mismatch in 38.5% infants, over diagnosis in 10.5% and under diagnosis was present in 3% infants of 0-2 months of age. Conclusion: This study had good diagnostic agreement and only 3%of infants were underdiagnosed.