Elastography in clinical practice.
Breast cancer; Breast mass; Breast Neoplasms – Ultrasonography; Breast Neoplasms/*diagnostic imaging; Computer Assisted – Methods; Computer-Assisted/methods; Elasticity Imaging Techniques/*methods; Elastography; Female; Female – Ultrasonography; Female/diagnostic imaging; Genital Diseases; Humans; Image Interpretation; Liver Cirrhosis – Ultrasonography; Liver Cirrhosis/*diagnostic imaging; Liver fibrosis; Male; Mammary/*methods; Musculoskeletal Diseases – Ultrasonography; Musculoskeletal Diseases/diagnostic imaging; Prostate cancer; Prostatic Neoplasms – Ultrasonography; Prostatic Neoplasms/*diagnostic imaging; Sensitivity and Specificity; Thyroid mass; Thyroid Neoplasms – Ultrasonography; Thyroid Neoplasms/*diagnostic imaging; Ultrasonography; Ultrasonography – Methods; Ultrasound
Elastography is a new technique that evaluates tissue stiffness. There are two elastography methods, strain and shear wave elastography. Both techniques are being used to evaluate a wide range of applications in medical imaging. Elastography of breast masses and prostates have been shown to have high accuracy for characterizing masses and can significantly decrease the need for biopsies. Shear wave elastography has been shown to be able to detect and grade liver fibrosis and may decrease the need for liver biopsy. Evaluation of other organs is still preliminary. This article reviews the principles of elastography and its potential clinical applications.
Barr Richard G
Radiologic clinics of North America
2014
2014-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.rcl.2014.07.002" target="_blank" rel="noreferrer noopener">10.1016/j.rcl.2014.07.002</a>
Real-time ultrasound elasticity of the breast: initial clinical results.
*Elasticity Imaging Techniques; *Image Processing; Adult; Aged; Biopsy; Breast; Breast – Pathology; Breast Diseases/diagnostic imaging/pathology; Breast Neoplasms – Diagnosis; Breast Neoplasms/*diagnostic imaging/*pathology; Computer-Assisted; Data Analysis Software; Diagnosis; Differential; Elasticity; Equipment and Supplies; Female; Humans; Immunohistochemistry; Mammary/*methods; Middle Aged; Needle; Ohio; Sensitivity and Specificity; Ultrasonography
PURPOSE: To determine the sensitivity and specificity of a real-time elasticity imaging (EI) ultrasound (US) system in the characterization of breast lesions as benign or malignant. METHODS: A total of 208 patients with 251 lesions were scheduled to undergo a US-guided breast biopsy for a mass identified on B-mode US, and each received a real-time elasticity image of the lesion before the biopsy. The lesion size measurements were obtained, and the EI/B-mode size ratio was obtained. The pathology report was obtained and correlated with the EI/B-mode ratio. An EI/B-mode ratio equal to or greater than 1 was considered malignant lesion, whereas EI/B-mode ratios of less than 1 were considered benign. Sensitivity, specificity, positive predictive values, and negative predictive values were calculated. RESULTS: Of the 251 lesions biopsied, 197 were pathologically benign, and 54 were malignant. Of the 54 malignant lesions, all had an EI/B-mode ratio equal to or greater than 1. Of the 197 benign lesions, 187 had an EI/B-mode ratio of less than 1. Ten benign lesions had an EI/B-mode ratio of greater than 1. The benign lesions that had an EI/B-mode ratio of greater than 1 were lesions with dense fibrosis, and in addition, a characteristic artifact was identified, which was visualized in all simple and complex cysts. The results correspond with a sensitivity of 100%, specificity of 95%, a positive predictive value of 84%, and a negative predictive value of 100%. CONCLUSIONS: Initial results of a real-time EI system for characterization of breast lesions suggest this technique can provide significant new diagnostic information. As a result, this information may significantly improve the ability to select patients for breast biopsy, resulting in a reduction in the number of benign breast biopsies.
Barr Richard G
Ultrasound quarterly
2010
2010-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/RUQ.0b013e3181dc7ce4" target="_blank" rel="noreferrer noopener">10.1097/RUQ.0b013e3181dc7ce4</a>
Agreement Between an Automated Volume Breast Scanner and Handheld Ultrasound for Diagnostic Breast Examinations.
automated breast ultrasound; Automated/*methods; breast; Breast Neoplasms/*diagnostic imaging; breast ultrasound; Breast/diagnostic imaging; diagnostic workup; Female; Humans; Mammary/*instrumentation/*methods; Middle Aged; Observer Variation; Pattern Recognition; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography; ultrasound; volumetric breast ultrasound
OBJECTIVES: To compare the agreement and interobserver variability of diagnostic handheld ultrasound (US) and a single volume on an automated breast volume scanner (ABVS) and to determine whether there was a significant difference if the ABVS was used by a sonographer or mammographic technologist. METHODS: Ninety patients scheduled for diagnostic US examinations were randomized to either handheld US or the ABVS first. The AVBS was randomized between a sonographer and a mammographic technologist performing the study. The studies were blinded, randomized, and read by 2 radiologists. The lesion with the highest Breast Imaging Reporting and Data System (BI-RADS) score was used in the analysis. Final diagnoses were made by core biopsy or follow-up for 2 years. Lesions included 9 malignant and 81 benign. RESULTS: The 90 patients had a mean age +/- SD of 53.1 +/- 16.3 years. The kappa value for agreement between the ABVS and handheld US was 0.831 (95% confidence interval, 0.744-0.925), whereas the global agreement for a 7-point BI-RADS score was 0.488 (0.372-0.560). The agreement between the ABVS and handheld US was nearly the same when the ABVS was used by a mammographic technologist (kappa = 0.858 [0.723-0.963]) or sonographer (kappa = 0.803 [0.596-1.000]; P = .47). The areas under the receiver operating characteristic curves for characterization by the ABVS were 0.91 (0.84-0.96) for reader 1 and 0.91 (0.83-0.96) for reader 2; those for handheld US were 0.91 (0.84-0.96) for reader 1 and 0.83 (0.74-0.90) for reader 2, with no statistical difference. The agreement based on pathologic images was kappa = 0.831 (0.718-0.944); for handheld US, kappa = 0.795 (0.623-0.967); and for the AVBS, kappa = 0.869 (0.725-1.000). CONCLUSIONS: Performing a single-view diagnostic ABVS examination has good agreement with a handheld diagnostic US workup. There is no difference if the ABVS is used by a sonographer or mammographic technologist.
Barr Richard G; DeVita Robert; Destounis Stamatia; Manzoni Federica; De Silvestri Annalisa; Tinelli Carmine
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
2017
2017-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/jum.14248" target="_blank" rel="noreferrer noopener">10.1002/jum.14248</a>
Shear wave ultrasound elastography of the prostate: initial results.
*Endosonography; Aged; Biopsy; Biopsy – Methods; Diagnosis; Differential; Elasticity; Elasticity Imaging Techniques/*methods; Equipment and Supplies; Follow-Up Studies; Health Screening; Human; Humans; Magnetic Resonance Imaging; Male; Middle Age; Middle Aged; Ohio; Predictive Value of Tests; Prospective Studies; Prostate – Analysis; Prostate – Anatomy and Histology; Prostate-Specific Antigen – Blood; Prostate/*diagnostic imaging/pathology; Prostatic Hypertrophy; Prostatic Neoplasms – Diagnosis; Prostatic Neoplasms – Pathology; Prostatic Neoplasms/*diagnostic imaging/pathology; Rectum; ROC Curve; Sensitivity and Specificity; Spectrum Analysis; Ultrasonography – Methods
PURPOSE: This prospective study was to evaluate shear wave elastography (SWE) in the detection of prostate cancer (PC). METHODS: Patients scheduled for a transrectal ultrasound (TRUS) biopsy of the prostate because of elevated prostate-specific antigen levels or abnormal digital rectal examination result underwent a standard TRUS and SWE. A second TRUS examination and sextant biopsy by a second physician blinded to SWE results was then performed. Pathologic result was reviewed, and sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. RESULTS: A total of 53 patients (318 sextants) participated in the study. Mean age was 64.2 years (range, 53-79 years). A total of 26 foci of PC were detected in 11 patients (20.7%). On the basis of the receiver operating characteristic curve, a value of 37 kPa was used as the cutoff between benign and malignant. This produced a sensitivity of 96.2% (25/26), a specificity of 96.2% (281/292), a PPV of 69.4% (25/36), and an NPV of 99.6% (281/282). Six (55%) of 11 false-positive samples were secondary to benign calcifications. The Young modulus of PC ranged from 30 to 110 kPa (mean [SD], 58.0 [20.7] kPa). At the patient level, if a cutoff of 40 kPa was used, all PCs would have been detected, and the positive biopsy rate would be 11 (50%) of 22 compared to 11 (20.8%) of 53 without SWE–a 140% increase in the positive biopsy rate. CONCLUSIONS: Shear wave elastography has a high sensitivity, specificity, PPV, and NPV for the detection of PC. With a high PPV, patients with elevated prostate-specific antigen levels or abnormal results in the digital rectal examination and negative SWE may not require biopsy. This could significantly reduce the negative biopsy rate in PC detection.
Barr Richard G; Memo Richard; Schaub Carl R
Ultrasound quarterly
2012
2012-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/RUQ.0b013e318249f594" target="_blank" rel="noreferrer noopener">10.1097/RUQ.0b013e318249f594</a>
Speed of sound imaging: improved image quality in breast sonography.
*Artifacts; Breast Diseases – Classification; Breast Diseases – Diagnosis; Continuing (Credit); Education; Equipment and Supplies; Female; Funding Source; Human; Humans; Image Enhancement/*methods; Mammary/*methods; Middle Aged; Observer Variation; Quality of Health Care; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography; Ultrasonography – Methods
PURPOSE: The purpose of this study was to evaluate blindly breast ultrasound images corrected for the speed of sound in breast tissue compared with conventional images. MATERIALS AND METHODS: In this study, 409 images from 153 patients were obtained on an Antares Ultrasound system. The system was modified to process the radiofrequency data with the standard 1540 m/s as the speed of sound and at a corrected speed of sound for breast tissue. An offline
Barr Richard G; Rim Alice; Graham Ruffin; Berg Wendie; Grajo Joseph R
Ultrasound quarterly
2009
2009-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/RUQ.0b013e3181b789aa" target="_blank" rel="noreferrer noopener">10.1097/RUQ.0b013e3181b789aa</a>
Shear-wave elastography of the breast: value of a quality measure and comparison with strain elastography.
80 and over; 80 and Over; Adolescence; Adolescent; Adult; Aged; Biopsy; Breast Neoplasms – Pathology; Breast Neoplasms – Radiography; Breast Neoplasms – Ultrasonography; Breast Neoplasms/*diagnostic imaging/pathology; Elasticity Imaging Techniques/*methods; Female; Human; Humans; Mammary/*methods; Mammography; Middle Age; Middle Aged; Needle; Predictive Value of Tests; Sensitivity and Specificity; Signal-To-Noise Ratio; Ultrasonography; Ultrasonography – Methods
PURPOSE: To determine whether addition of quality measure (QM) of shear-wave (SW) velocity (Vs) estimation can increase SW elastography sensitivity for breast cancer. MATERIALS AND METHODS: With written informed consent, this institutional review board-approved, HIPAA-compliant study included 143 women (mean age, 48.5 years +/- 8.7) scheduled for breast biopsy. Mean lesion size was 16.4 mm +/- 11.8; 95 (66%) lesions were benign; 48 (34%), malignant. If more than one lesion was present, lesion with highest Breast Imaging Reporting and Data System (BI-RADS) category was chosen. If there were more than one with highest BI-RADS category, a lesion was randomly selected. Conventional ultrasonography (US), strain elastography, and SW elastography were performed with QM. QM assesses SW quality to provide accurate Vs. Lesions were evaluated for Vs and QM (high or low). Lesions with Vs of less than 4.5 m/sec were classified benign; lesions with Vs of 4.5 m/sec or greater, malignant. Results were correlated with pathologic findings. Vs data with or without incorporating QM were used to determine SW elastography diagnostic performance. Binomial proportions and exact 95% confidence intervals (CIs) were calculated. RESULTS: In 95 benign lesions, 13 (14%) had no SW elastography signal; 77 (81%), Vs of less than 4.5 m/sec; and five (5%), Vs of 4.5 m/sec or greater. In 48 malignant lesions, eight (17%) had no SW elastography signal; 20 (42%), Vs of less than 4.5 m/sec; and 20 (42%), V of 4.5 m/sec or greater. QM was low in 17 of 20 (85%) malignant lesions with Vs of less than 4.5 m/sec. Without QM, using Vs of 4.5 m/sec or greater as test positive, SW elastography had lesion-level sensitivity of 50% (95% CI: 34%, 66%); specificity, 94% (95% CI: 86%, 98%); positive predictive value (PPV), 80% (95% CI: 59%, 93%); and negative predictive value (NPV), 79% (95% CI: 70%, 87%). Using QM where additional lesions with both low Vs and low QM were treated as test positive, SW elastography had lesion-level sensitivity of 93% (95% CI: 80%, 98%); specificity, 89% (95% CI: 80%, 95%); PPV, 80% (95% CI: 66%, 91%); and NPV, 96% (95% CI: 89%, 99%). CONCLUSION: Addition of QM can improve SW elastography sensitivity, with no significant change in specificity.
Barr Richard G; Zhang Zheng
Radiology
2015
2015-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1148/radiol.14132404" target="_blank" rel="noreferrer noopener">10.1148/radiol.14132404</a>
Effects of precompression on elasticity imaging of the breast: development of a clinically useful semiquantitative method of precompression assessment.
Adult; Female; Humans; Middle Aged; Young Adult; Ultrasonography; Sensitivity and Specificity; Breast Neoplasms/*diagnostic imaging; Reproducibility of Results; Elasticity Imaging Techniques/*methods; *Algorithms; Artifacts; Image Enhancement/methods; Palpation/*methods; Image Interpretation; Mammary/*methods; Computer-Assisted/*methods
OBJECTIVES: Elastography of the breast is a new technique for characterization of breast lesions. The reproducibility of elastographic techniques has been questioned. Precompression is known to effect elastographic results. This study determined the effect of precompression on clinical images and proposes a method to semiquantify the amount of precompression applied. METHODS: Ten patients with different breast tissue types were evaluated with shear wave and strain elastography with varying amounts of precompression. The changes in the shear wave speed and images were documented. A semiquantitative method for determining the amount of precompression applied is presented. The reproducibility of the technique was determine by repeated measurements by 3 sonographers. RESULTS: Precompression substantially changes the elastographic results of patient images on both strain and shear wave elastography. Fat can have the same elasticity as cancer with clinically possible amounts of precompression. The proposed method for determining the amount of precompression applied has variability of less than 10%, which is within the error of the technique and would not affect clinical results. Four zones of precompression are identified, which are useful for explaining the effects of precompression on both strain and shear wave imaging. CONCLUSIONS: Precompression is a substantial factor in obtaining accurate results with elastography. A proposed simple, easily applied technique can be used to semiquantify the amount of precompression applied. Precompression should be minimized in obtaining breast clinical images.
Barr Richard G; Zhang Zheng
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
2012
2012-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.7863/jum.2012.31.6.895" target="_blank" rel="noreferrer noopener">10.7863/jum.2012.31.6.895</a>
Effectiveness of a group exercise program in a long-term care facility: a randomized pilot trial.
Female; Male; Aged; Sensitivity and Specificity; Prospective Studies; Age Factors; Sex Factors; Analysis of Variance; Patient Compliance; Pliability; Frail Elderly; Nursing Homes; Confidence Intervals; Inpatients; Human; Descriptive Statistics; P-Value; Repeated Measures; Data Analysis Software; Pilot Studies; Clinical Trials; Summated Rating Scaling; Clinical Assessment Tools; Analysis of Covariance; Outcomes (Health Care); Range of Motion; Random Assignment; Treatment Outcomes; Gerontologic Care; Long Term Care; Functional Status; Geriatric Functional Assessment; Crossover Design; Housing for the Elderly; Muscle Strengthening; Recreation; 80 and Over; Group Exercise – In Old Age
Objective:The purpose of this pilot was to determine whether a strength and flexibility program in frail long-term care facility (LTC) residents would result in improved function.Design:A prospective, randomized, controlled, semicrossover trial was designed with participants assigned either to group exercise (EX) or recreational therapy (C). In the EX group, the intervention continued for 1 year. In the C group, recreation continued for 6 months; these controls were then crossed over to the same exercise intervention as the EX group and followed for an additional 6 months. Functional outcomes were measured at baseline and 3, 6, 9, and 12 months for both groups.Setting:A LTC facility, which included both assisted living (AL) and nursing home (NH) residents.Participants:Twenty frail residents (5 from NH, 15 from AL) aged 75 to 99 years at one LTC facility.Intervention:After random group assignment, the EX group met 1 hour three times per week. An exercise physiologist and LTC staff conducted sessions which included seated range of motion (ROM) exercises and strength training using simple equipment such as elastic resistance bands (therabands) and soft weights. The C group met three times per week and participated in activities such as painting during the first 6 months, before crossing over to exercise.Measurements and Methods:Objective measures of physical and cognitive function were obtained at baseline and 3, 6, 9, and 12 months using the timed get-up-and-go test (TUG), Berg balance scale, physical performance test (PPT), and mini-mental status exam (MMSE). Because we were interested in the impact of exercise on multiple endpoints and to protect the type I error rate, a global hypothesis test was used.Results:There was a significant overall impact across the four measures of the exercise intervention (P = 0.013). Exercise benefit as indicated by the difference between exercise and control conditions showed exercise decreased TUG by 18 seconds, which represents an effect size (in standard deviation units) of 0.50, increased PPT scores by 1.3, with effect size = 0.40, increased Berg scores by 4.8, with effect size of 0.32, and increased MMSE by 3.1, with effect size = 0.54. Except for the Berg, 90% confidence intervals on these exercise effects excluded 0.Conclusion:Frail elderly in a LTC facility were able to participate and benefit from a strength training program. The program was delivered with low-cost equipment by an exercise physiologist and LTC staff. The advantage of such a program is that it provides recreational and therapeutic benefits.
Baum EE; Jarjoura D; Polen AE; Faur D; Rutechi G
Journal of the American Medical Directors Association
2003
2003-04-03
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<a href="http://doi.org/10.1016/s1525-8610(04)70279-0" target="_blank" rel="noreferrer noopener">10.1016/s1525-8610(04)70279-0</a>
Pediatric appendiceal ultrasound: accuracy, determinacy and clinical outcomes.
Appendicitis; Appendicitis – Radiography; Appendicitis – Ultrasonography; Appendicitis/*diagnostic imaging; Appendix; Child; Children; Diagnosis; Diagnostic accuracy; Differential; Female; Human; Humans; Male; Patient Selection; Retrospective Design; Retrospective Studies; Sensitivity and Specificity; Tomography; Ultrasonography; Ultrasound; X-Ray Computed
BACKGROUND: Ultrasonography is considered the most appropriate initial imaging study in the evaluation of acute appendicitis in children but has recently come under criticism with reports of low specificity and high indeterminate study rates, particularly when used in obese patients and patients early in the course of their disease, or when performed by sonographers with limited experience. OBJECTIVE: To (1) assess the impact of patient factors (gender, age, body mass index, and symptom duration) and system factors (call status or year of exam) on pediatric appendiceal US accuracy and indeterminate study rate, (2) assess the impact of indeterminate study results on follow-up CT and negative laparotomy rates and (3) present strategies to reduce the rate of indeterminate US studies and improve accuracy. MATERIALS AND METHODS: We retrospectively reviewed all US reports performed for the assessment of acute appendicitis in children \textless18 years old at Mayo Clinic Rochester from January 2010 to June 2014. RESULTS: A total of 790 US examinations were performed in 452 girls (57%) and 338 boys (43%). The prevalence of appendicitis was 18.5% (146/790). There were 109 true-positive, 440 true-negative, 17 false-positive, 6 false-negative, 218 equivocal and 41 technically inadequate US studies. A definitive interpretation was made in 72% of the studies, with an accuracy, sensitivity and specificity of 0.960, 0.948 and 0.963, respectively. No patient or system factors significantly affected US accuracy. Indeterminate studies (28%) had significantly higher CT utilization (46% vs. 11%) and normal appendectomy rates (6.9% vs. 3.5%). CONCLUSION: US should be the initial imaging study of choice for pediatric appendicitis. When a definitive interpretation was given, the accuracy was 96%, was independent of patient and system factors and resulted in reduced follow-up CTs and negative laparotomies. Accuracy can be increased by requiring the presence of periappendiceal inflammatory changes prior to interpreting a mildly distended appendix as positive for acute appendicitis. The indeterminate study rate can be reduced by not requiring visualization of the normal appendix for the exclusion of acute appendicitis.
Binkovitz Larry A; Unsdorfer Kyle M L; Thapa Prabin; Kolbe Amy B; Hull Nathan C; Zingula Shannon N; Thomas Kristen B; Homme James L
Pediatric radiology
2015
2015-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s00247-015-3432-7" target="_blank" rel="noreferrer noopener">10.1007/s00247-015-3432-7</a>
Evaluation of a screening interview for restless legs syndrome.
80 and over; ACTION spectrum; Adult; Aged; Brain Diseases/complications; Cardiovascular Diseases/complications; EPIDEMIOLOGICAL research; Female; Humans; INTERVIEWING; Interviews as Topic; Male; Middle Aged; MOVEMENT disorders; Reproducibility of Results; RESTLESS legs syndrome; Restless Legs Syndrome/complications/*diagnosis; Sensitivity and Specificity
OBJECTIVES: We evaluated a fully structured interview for restless legs syndrome (RLS) for potential use in primary care settings and in epidemiological research. METHODS: Seventy-four veterans were recruited at Veterans Affairs outpatient clinics. The interview was administered telephonically by trained non-clinicians (time 1) and readministered face to face (time 2). A physician conducted gold standard examinations. We calculated sensitivity, specificity and reproducibility. RESULTS: Reproducibility was low (kappa = 0.34, P \textless 0.01), but was higher for interviews repeated within 1 year (kappa = 0.55, P \textless 0.01). Including those reporting \textgreater or =3 symptoms as cases, sensitivity ranged from 63% (time 1) to 75% (time 2). Specificity ranged from 88% to 71%. CONCLUSIONS: The sensitivity and specificity reported here are lower than previously reported in specialty care. This interview for RLS might be useful for preliminary screening of patients with related complaints if followed by additional diagnostic maneuvers or might be used in observational epidemiological research.
Bourguet C C; Ober S K; Panzner M P; Baughman K R
Acta neurologica Scandinavica
2009
2009-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1600-0404.2008.01117.x" target="_blank" rel="noreferrer noopener">10.1111/j.1600-0404.2008.01117.x</a>
Hematologic counts as predictors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.
*Blood Cell Count; *Inflammation; *Intracranial vasospasm; *Subarachnoid hemorrhage; *Transcranial Doppler sonography; Anemia/blood/diagnosis; Brain Ischemia/blood/complications/*diagnosis/epidemiology; Cerebrovascular Circulation/physiology; Critical Care; Databases; Doppler; Factual; Female; Humans; Leukocytosis/blood/diagnosis; Logistic Models; Male; Middle Aged; Models; Odds Ratio; Ohio/epidemiology; Sensitivity and Specificity; Subarachnoid Hemorrhage/*complications/diagnostic imaging; Theoretical; Transcranial; Ultrasonography
PURPOSE: Aneurysmal subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality, but currently no single clinical method or ancillary test can reliably predict which subset of patients will develop delayed cerebral ischemia (DCI). The aim of this study was to find hematologic derangements and clinical factors present during the first 7 days after bleeding that could help identify patients at risk for development of DCI. MATERIALS AND METHODS: Databank analysis of patients with SAH admitted between 2010 and 2012 in a single center. Data from demographics, imaging, laboratory, and clinical factors were collected. Statistical testing was conducted to test for association to the outcome, and multivariate logistic regression was used to design a predictive model. RESULTS: Of 55 patients, 14 developed DCI (25%). Anemia and leukocytosis on the third day after bleeding were significantly correlated with the outcome (for anemia: P\textless.032; confidence interval, 1.12-15.16; odds ratio, 4.12; for leukocytosis: P\textless.046; confidence interval, 1.03-26.13; odds ratio, 5.18). Anemia and leukocytosis were still statistically significant after adjustment for age, sex, modified Fisher scale, and Hunt-Hess scale. CONCLUSION: The presence of leukocytosis and anemia during the third day after SAH was statistically correlated with the occurrence of DCI.
Da Silva Ivan Rocha Ferreira; Gomes Joao Antonio; Wachsman Ari; de Freitas Gabriel Rodriguez; Provencio Jose Javier
Journal of critical care
2017
2017-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jcrc.2016.09.011" target="_blank" rel="noreferrer noopener">10.1016/j.jcrc.2016.09.011</a>
Effect of Precompression on the Power Doppler Assessment of Breast Lesion Vascularity.
Adult; Female; Humans; Middle Aged; Aged; Ultrasonography; Sensitivity and Specificity; breast cancer; breast ultrasound; Image-Guided Biopsy; *Ultrasonography; breast mass; Breast Neoplasms/*blood supply/*diagnostic imaging/pathology; Breast/blood supply/diagnostic imaging/pathology; power Doppler sonography; precompression; preload; vascularity; Color; Diagnosis; 80 and over; Differential; Doppler; Neovascularization; Interventional; Mammary; Pathologic/diagnostic imaging/*pathology
OBJECTIVES: To evaluate the effect of precompression on power Doppler visualization of blood flow in breast masses. METHODS: This Institutional Review Board-approved and Health Insurance Portability and Accountability Act-compliant study evaluated 30 patients with breast masses (16 benign and 14 malignant) undergoing ultrasound-guided breast biopsy. A computational mathematics program was used to calculate the number of color pixels in a region of interest at various degrees of compression of the breast by the transducer. The amount of precompression was calculated as previously described. The percentage of color pixels compared to minimal compression was plotted against the percentage of precompression. The amount of precompression needed to decrease the number of color pixels by 50% and 100% was calculated. The differences between benign and malignant lesions were compared. RESULTS: The mean percentages of precompression +/- SD needed to decrease the number of color voxels by 50% in were 15.9% +/- 6.43% (range, 8%-30%) for benign lesions and 14.0% +/- 4.17% (range, 8%-20%) for malignant lesions (P = .35). The percentages of precompression needed to decrease the number of color pixels by 100% in were 34.7% +/- 12.33% (range, 23%-62%) for benign lesions and for malignant lesions 26.7% +/- 3.89% (range, 18%-31%), which were statistically significant (P = .027). CONCLUSIONS: The amount of precompression normally used when obtaining B-mode images can substantially decrease the number of color voxels on power Doppler sonography. When performing quantitative work on Doppler evaluation of breast lesions, precompression needs to be controlled.
DeVita Robert; Barr Richard G
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
2017
2017-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.7863/ultra.16.01024" target="_blank" rel="noreferrer noopener">10.7863/ultra.16.01024</a>
Thyroid Ultrasound: State of the Art Part 1 - Thyroid Ultrasound reporting and Diffuse Thyroid Diseases.
Humans; Scales; Sensitivity and Specificity; Thyroid Diseases; Thyroid Diseases/*diagnostic imaging; Thyroid Gland; Thyroid Gland/diagnostic imaging; Ultrasonography – Methods; Ultrasonography/*methods
Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.
Dighe Manjiri; Barr Richard; Bojunga Jorg; Cantisani Vito; Chammas Maria Cristina; Cosgrove David; Cui Xin-Wu; Dong Yi; Fenner Franziska; Radzina Maija; Vinayak Sudhir; Xu Jun-Mei; Dietrich Christoph F
Medical ultrasonography
2017
2017-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.11152/mu-980" target="_blank" rel="noreferrer noopener">10.11152/mu-980</a>
Thyroid Ultrasound: State of the Art. Part 2 - Focal Thyroid Lesions.
*Practice Guidelines as Topic; Computer Assisted – Methods; Computer-Assisted/*methods; Diagnosis; Differential; Evidence-Based; Evidence-Based Medicine; Humans; Image Enhancement – Methods; Image Enhancement/methods; Image Interpretation; Medical Practice; Practice Guidelines; Reproducibility of Results; Scales; Sensitivity and Specificity; Thyroid Gland; Thyroid Gland – Pathology; Thyroid Gland/*diagnostic imaging/pathology; Thyroid Nodule; Thyroid Nodule – Pathology; Thyroid Nodule/*diagnostic imaging/pathology; Ultrasonography – Methods; Ultrasonography – Standards; Ultrasonography/*methods/*standards
Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.
Dighe Manjiri; Barr Richard; Bojunga Jorg; Cantisani Vito; Chammas Maria Cristina; Cosgrove David; Cui Xin-Wu; Dong Yi; Fenner Franziska; Radzina Maija; Vinayak Sudhir; Xu Jun-Mei; Dietrich Christoph F
Medical ultrasonography
2017
2017-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.11152/mu-999" target="_blank" rel="noreferrer noopener">10.11152/mu-999</a>
Difficulty in predicting bacteremia in elderly emergency patients.
80 and over; Aged; Bacteremia/*diagnosis/microbiology; Bacteriological Techniques; Blood Chemical Analysis; Cognition Disorders/diagnosis; Confidence Intervals; Escherichia coli/isolation & purification; Female; Hospitals; Humans; Male; Odds Ratio; Predictive Value of Tests; Regression Analysis; Retrospective Studies; Sensitivity and Specificity; Teaching; Urinary Tract Infections/microbiology
STUDY OBJECTIVES: To characterize the clinical presentation and identify factors predictive of bacteremia in elderly patients. DESIGN: Retrospective review of emergency department charts, hospital records, and microbiology reports. SETTING: Community teaching hospital with annual ED census of 65,000 adults. PARTICIPANTS: Seven hundred fifty elderly patients (aged 65 to 99 years) who were evaluated by the emergency physician, had blood cultures obtained in the ED, and were hospitalized with a suspected infectious process during a 12-month period. MEASUREMENTS: Records were analyzed for demographic information, underlying diseases, clinical presentation, laboratory findings, sources of infection, and causative organisms. Using contingency tables, 79 patients with positive blood cultures were compared with a random sample of 136 patients with sterile blood cultures to identify clinical variables significantly (P less than .05) associated with bacteremia. Logistic regression analysis was performed with significant factors to develop a model to predict bacteremia. Sensitivity, specificity, and predictive values were calculated for the model. MAIN RESULTS: The prevalence of bacteremia was 10.6%. Escherichia coli was the most commonly isolated pathogen (29% of cases), and the urinary tract was the most common source of infection (44.3% of cases). Logistic regression analysis showed that altered mental status (odds ratio, 2.88; 95% confidence interval [Cl], 1.52 to 5.50), vomiting (odds ratio, 2.63; 95% Cl, 1.16 to 6.15), and WBC band forms of more than 6% (0.06) (odds ratio, 3.50; 95% Cl, 1.58 to 5.27) were independent predictors of bacteremia. The presence of at least one of these three factors had a sensitivity of 0.85 (95% Cl, 0.75 to 0.92) and a specificity of 0.46 (95% Cl, 0.38 to 0.55) for predicting bacteremia in the study group. The positive predictive value was 0.16 (95% Cl, 0.12 to 0.19) and the negative predictive value was 0.96 (95% Cl, 0.94 to 0.98) for the ED patient group that met inclusion criteria. CONCLUSION: Elderly patients fail to manifest identifiable clinical features indicative of bloodstream infection. The sensitivity and specificity of the best statistical model for identifying bacteremic elderly patients suggest that clinical indicators alone are unreliable predictors of bacteremia in the geriatric ED population studied.
Fontanarosa P B; Kaeberlein F J; Gerson L W; Thomson R B
Annals of emergency medicine
1992
1992-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0196-0644(05)81032-7" target="_blank" rel="noreferrer noopener">10.1016/s0196-0644(05)81032-7</a>
Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography.
Humans; Male; Female; Unnecessary Procedures; Infant; Adolescent; Child; Sensitivity and Specificity; Child Preschool; Retrospective Studies; Tomography X-Ray Computed; Observer Variation; Bronchoscopy; Bronchoscopy; Computed tomography; Foreign Bodies/diagnostic imaging/therapy; Foreign body aspiration; Respiratory System/diagnostic imaging
BACKGROUND: Bronchoscopy is the standard of care for diagnosis and treatment of foreign body aspiration (FBA). Drawbacks of this approach include its invasiveness, the potential for exacerbation of reactive airway disease, and the need for general anesthesia. Computed tomography (CT) can potentially identify patients with FBA, thereby avoiding unnecessary bronchoscopies in patients with at-risk reactive airways. METHODS: A retrospective review was performed to identify patients who underwent CT and/or bronchoscopy for suspected foreign body aspiration (FBA) from June 2012 to September 2018. Variables included clinical history, exam findings, radiographic findings, and operative findings. A telephone survey was performed for patients who had a CT without bronchoscopy. Three radiologists performed rereads of all CTs. RESULTS: A total of 133 patients were evaluated for FBA, and 84 were treated with bronchoscopy. For those with a CT demonstrating a foreign body, findings were confirmed on bronchoscopy in 17/18 (94.4%). For those with bronchoscopy alone, 39/64 (60.9%) were found to have a foreign body (p < 0.01). CT excluded FBA in 49 patients. Sensitivity was 100%, specificity was 98%, and interobserver reliability was excellent (κ = 0.88). CONCLUSION: CT is an accurate and reliable diagnostic tool in the evaluation of FBA that can increase the rate of positive bronchoscopy. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: Level III.
Gibbons AT; Casar BAM; Hanke RE; McNinch NL; Person A; Mehlman T; Rubin M; Ponsky TA
Journal of Pediatric Surgery
2020
2020-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.jpedsurg.2019.09.045" target="_blank" rel="noreferrer noopener">10.1016/j.jpedsurg.2019.09.045</a>
A comparison of the National Ambulatory Medical Care Survey (NAMCS) measurement approach with direct observation of outpatient visits.
80 and over; Adolescent; Adult; Aged; Ambulatory Care/*statistics & numerical data; Bias; Child; Family Practice/*statistics & numerical data; Female; Health Care Surveys/*methods/standards; Humans; Infant; Male; Middle Aged; Observation/*methods; Office Visits/*statistics & numerical data; Ohio; Preschool; Research Design/standards; Sensitivity and Specificity; Time Factors
BACKGROUND: The National Ambulatory Medical Care Survey (NAMCS) informs a wide range of important policy and clinical decisions by providing nationally representative data about outpatient practice. However, the validity of the NAMCS methods has not been compared with a reference standard. METHODS: Office visits of 549 patients visiting 30 family physicians in Northeastern Ohio were observed by trained research nurses. Visit content measured by direct observation was compared with data reported by physicians using the 1993 NAMCS form. RESULTS: Outpatient visit physician reports of procedures and examinations using the NAMCS method showed generally good concordance with direct observation measures, with kappas ranging from 0.39 for ordering a chest x-ray to 0.86 for performance of Pap smears. Concordance was generally lower for health behavior counseling, with kappas ranging from 0.21 for alcohol counseling to 0.60 for smoking cessation advice. The NAMCS form had high specificity (range, 0.90-0.99) but variable (range, 0.12-.84) sensitivity compared with direct observation, with the lowest sensitivities for health behavior counseling. The NAMCS physician report method overestimated visit duration in comparison with direct observation (16.5 vs. 12.8 minutes). CONCLUSIONS: Compared with direct observation of outpatient visits, the NAMCS physician report method is more accurate for procedures and examinations than for health behavior counseling. Underreporting of behavioral counseling and overreporting of visit duration should lead to caution in interpreting findings based on these variables.
Gilchrist Valerie J; Stange Kurt C; Flocke Susan A; McCord Gary; Bourguet Claire C
Medical care
2004
2004-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/01.mlr.0000114916.95639.af" target="_blank" rel="noreferrer noopener">10.1097/01.mlr.0000114916.95639.af</a>
Association Between Features of Spontaneous Late Preterm Labor and Late Preterm Birth.
Humans; Pregnancy; Female; Risk Factors; Logistic Models; Infant Newborn; Sensitivity and Specificity; Prognosis; Gestational Age; Premature Birth; Glucocorticoids/administration & dosage; Pregnancy Trimester Third; Labor Stage First; Obstetric Labor Premature; Betamethasone/administration & dosage; Cervix Uteri; Parity; Respiratory Tract Diseases/prevention & control
OBJECTIVE: This study aimed to evaluate the association between clinical and examination features at admission and late preterm birth. STUDY DESIGN: The present study is a secondary analysis of a randomized trial of singleton pregnancies at 34(0/7) to 36(5/7) weeks' gestation. We included women in spontaneous preterm labor with intact membranes and compared them by gestational age at delivery (preterm vs. term). We calculated a statistical cut-point optimizing the sensitivity and specificity of initial cervical dilation and effacement at predicting preterm birth and used multivariable regression to identify factors associated with late preterm delivery. RESULTS: A total of 431 out of 732 (59%) women delivered preterm. Cervical dilation ≥ 4 cm was 60% sensitive and 68% specific for late preterm birth. Cervical effacement ≥ 75% was 59% sensitive and 65% specific for late preterm birth. Earlier gestational age at randomization, nulliparity, and fetal malpresentation were associated with late preterm birth. The final regression model including clinical and examination features significantly improved late preterm birth prediction (81% sensitivity, 48% specificity, area under the curve = 0.72, 95% confidence interval [CI]: 0.68-0.75, and p-value < 0.01). CONCLUSION: Four in 10 women in late-preterm labor subsequently delivered at term. Combination of examination and clinical features (including parity and gestational age) improved late-preterm birth prediction.
Glover AV; Battarbee AN; Gyamfi-Bannerman C; Boggess KA; Sandoval G; Blackwell SC; Tita ATN; Reddy UM; Jain L; Saade GR; Rouse DJ; Iams JD; Clark EAS; Chien EK; Peaceman AM; Gibbs RS; Swamy GK; Norton ME; Casey BM; Caritis SN; Tolosa JE; Sorokin Y; Manuck TA
American Journal of Perinatology
2020
2020-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1055/s-0039-1696641" target="_blank" rel="noreferrer noopener">10.1055/s-0039-1696641</a>
Relevance of routine admission electrocardiograms for psychiatric patients.
Adult; Aged; Arrhythmias; Cardiac/diagnosis/*epidemiology/etiology; Comorbidity; Cost Savings; Diagnosis; Diagnostic Tests; Dual (Psychiatry); Electrocardiography/economics/*statistics & numerical data; Female; Humans; Male; Mental Disorders/diagnosis/*epidemiology/rehabilitation; Middle Aged; Myocardial Ischemia/diagnosis/*epidemiology/etiology; Patient Admission/economics/*statistics & numerical data; Routine/economics/*statistics & numerical data; Sensitivity and Specificity; Treatment Outcome
OBJECTIVE: To make clinically relevant recommendations for electrocardiogram (ECG) testing among psychiatric patients, the study examined the practice of ordering ECGs for this population. METHODS: The records of 4,045 patients consecutively admitted for psychiatric care to seven community teaching hospitals over one year were examined. The frequency of ECG orders was documented, and abnormal ECG results were grouped into two categories: relevant to psychiatric treatment (ischemia or conduction defects) and incidental to treatment (minor abnormalities and screening abnormalities). For those with abnormalities, additional cardiac follow-up data were recorded. Associations between ECG results and patients' characteristics were analyzed. RESULTS: ECGs were performed for 2,857 (71 percent) of first admissions, of which 2,225 (78 percent) showed neither relevant nor screening abnormalities. Eighteen percent of those tested had relevant abnormalities, most commonly a first-degree atrioventricular block or some evidence of a myocardial infarction. ECG screening abnormalities were found for another 4 percent, primarily left ventricular hypertrophy (3 percent), but no follow-up occurred for 46 percent of these patients. Among patients under 40 years of age, 8 percent had relevant abnormalities, and 3 percent had screening abnormalities. Among patients without apparent cardiac risk, 10 percent had relevant and 3 percent had screening abnormalities. More than half the patients who had a second or third admission during the year had a repeat ECG, even when previous ECGs were normal. CONCLUSIONS: Routine ECG is not an effective treatment or screening tool in this population, and substantial cost savings could result from more selective testing, particularly among young patients, those at low risk, and those with repeat admissions.
Heiselman D E; Bredle D L; Kessler E; Rutecki G W; Hines R M; Whittier F C; Bunn P D; Ognibene A J
Psychiatric services (Washington, D.C.)
1997
1997-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1176/ps.48.10.1323" target="_blank" rel="noreferrer noopener">10.1176/ps.48.10.1323</a>
The FDA's generic-drug approval process: similarities to and differences from brand-name drugs.
Clinical Trials; Drug Approval/*methods; Drug Labeling/standards; Drugs; Female; Generic/administration & dosage/*pharmacology; Humans; Male; Pharmaceutical Preparations/administration & dosage; Phase I as Topic; Phase II as Topic; Phase III as Topic; Sensitivity and Specificity; Therapeutic Equivalency; United States; United States Food and Drug Administration/*standards
Kefalas Costas H; Ciociola Arthur A
The American journal of gastroenterology
2011
2011-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1038/ajg.2011.29" target="_blank" rel="noreferrer noopener">10.1038/ajg.2011.29</a>
Sonographic appearance of the Angelchik prosthesis.
*Prostheses and Implants; Aged; Doppler; Esophagogastric Junction/*diagnostic imaging; Female; Fundoplication/*instrumentation/methods; Gastroesophageal Reflux/*therapy; Humans; Prosthesis Design; Sensitivity and Specificity; Silicones; Tomography; Ultrasonography; X-Ray Computed
The Angelchik prosthesis is a silicone-filled, doughnut-shaped device used for the surgical treatment of gastroesophageal reflux. This device appears on sonograms as a C-shaped, hypoechoic structure with nonspecific Doppler waveforms. Because the Angelchik prosthesis is rarely used anymore, recently trained sonographers and radiologists may misinterpret this sonolucent appearance as an unusual vascular lesion. We report a case of an Angelchik prosthesis that was incidentally noted at the gastroesophageal junction on a routine abdominal sonographic examination.
Konez O; Nazinitsky K J; Goyal M; Collins R B; Boinapally S N
Journal of clinical ultrasound : JCU
2000
2000-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/(sici)1097-0096(200006)28:5%3C254::aid-jcu8%3E3.0.co;2-z" target="_blank" rel="noreferrer noopener">10.1002/(sici)1097-0096(200006)28:5%3C254::aid-jcu8%3E3.0.co;2-z</a>
A Case of Pancreatic Adenosquamous Carcinoma Obstructing the Common Bile and Pancreatic Ducts, Duodenum, and Gastric Outlet.
Adenosquamous/*complications/diagnosis/pathology; Aged; Carcinoma; Cholestasis/diagnosis/*etiology/pathology; Common Bile Duct/pathology; Duodenal Obstruction/diagnosis/*etiology/pathology; Duodenum/pathology; Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods; Female; Gastric Outlet Obstruction/diagnosis/*etiology/pathology; Humans; Pancreas/pathology; Pancreatic Ducts/*pathology; Pancreatic Neoplasms/*complications/diagnosis/pathology; Sensitivity and Specificity; Stomach/pathology
Kurdi Yahya M; Peck Joshua R; Roth Rachel; Conwell Darwin L
Pancreas
2016
2016-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MPA.0000000000000519" target="_blank" rel="noreferrer noopener">10.1097/MPA.0000000000000519</a>
Bile acids and cytokines inhibit the human cholesterol 7 alpha-hydroxylase gene via the JNK/c-jun pathway in human liver cells.
Bile Acids and Salts/*metabolism; Cells; Chenodeoxycholic Acid/pharmacology; Cholesterol 7-alpha-Hydroxylase/*genetics/metabolism; Cultured; Cytokines/*metabolism; Gene Expression Regulation; Genetic; Hepatocytes/*cytology/drug effects; Humans; Immunoblotting; In Vitro Techniques; Interleukin-1/pharmacology; Messenger/analysis; Probability; Proto-Oncogene Proteins c-jun/*metabolism; Reverse Transcriptase Polymerase Chain Reaction; RNA; Sensitivity and Specificity; Signal Transduction/genetics; Transcription
Cholesterol 7 alpha-hydroxylase (CYP7A1) of the bile acid biosynthesis pathway is suppressed by bile acids and inflammatory cytokines. Bile acids are known to induce inflammatory cytokines to activate the mitogen-activated protein kinase/c-Jun N-terminal kinase (JNK) signaling pathway that inhibits CYP7A1 gene transcription. c-Jun has been postulated to mediate bile acid inhibition of CYP7A1. However, the c-Jun target involved in the regulation of CYP7A1 is unknown. Human primary hepatocytes and HepG2 cells were used as models to study chenodeoxycholic acid (CDCA) and interleukin-1 beta (IL-1 beta) regulation of human CYP7A1 gene expression via real-time polymerase chain reaction, reporter assays, co-immunoprecipitation and chromatin immunocipitation (ChIP) assays. IL-1 beta and CDCA reduced CYP7A1 but induced c-Jun messenger RNA expression in human primary hepatocytes. IL-1beta inhibited human CYP7A1 reporter activity via the HNF4 alpha binding site. A JNK-specific inhibitor blocked the inhibitory effect of IL-1 beta on HNF4 alpha expression and CYP7A1 reporter activity. c-Jun inhibited HNF4 alpha and PPARgamma coactivator-1 alpha (PGC-1 alpha) coactivation of CYP7A1 reporter activity, whereas a dominant negative c-Jun did not. Co-immunoprecipitation and ChIP assays revealed that IL-1 beta and CDCA reduced HNF4 alpha bound to the CYP7A1 chromatin, and that c-Jun interacted with HNF4 alpha and blocked HNF4 alpha recruitment of PGC-1 alpha to the CYP7A1 chromatin. In conclusion, IL-1 beta and CDCA inhibit HNF4 alpha but induce c-Jun, which in turn blocks HNF 4 alpha recruitment of PGC-1 alpha to the CYP7A1 chromatin and results in inhibition of CYP7A1 gene transcription. The JNK/c-Jun signaling pathway inhibits bile acid synthesis and protects hepatocytes against the toxic effect of inflammatory agents.
Li Tiangang; Jahan Asmeen; Chiang John Y L
Hepatology (Baltimore, Md.)
2006
2006-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/hep.21183" target="_blank" rel="noreferrer noopener">10.1002/hep.21183</a>
Thermography as a diagnostic aid in sciatica.
*Lumbar Vertebrae; *Sacrum; *Thermography; Adult; Female; Humans; Intervertebral Disc Displacement/*complications; Male; Middle Aged; Observer Variation; Random Allocation; Rupture; Sciatica/*diagnosis/etiology; Sensitivity and Specificity; Single-Blind Method; Spontaneous
Thermography has been proposed as a diagnostic aid in patients with sciatica. Supporters of thermography state that: (a) normal patients have normal thermograms of their lower extremities, and (b) abnormal patients (with disk ruptures causing sciatica) have abnormal thermograms. To test these two hypotheses, 56 patients with clinically documented acute sciatica, with a supporting diagnostic study [computed tomography (CT), CT/myelography, and/or magnetic resonance imaging] showing a ruptured disk, had presurgical thermograms. One year after surgical intervention, they had to have had a documented success to surgical treatment intervention to stay in the study. These 56 patients were then matched with 56 control (normal) patients who had electronic thermograms. The 112 thermograms were then interpreted blindly by two thermographers. The sensitivity and specificity of thermography as a diagnostic aid in sciatica were statistically analyzed. The sensitivity of thermography (its ability to be positive when sciatica was clinically obvious) was 60% and 50% for the two thermographic readers. The specificity of thermography (its ability to be negative in asymptomatic patients) was 45% and 48% for the two thermographers. Our conclusions are no different than those published in 1985: thermography is not useful as a diagnostic aid in sciatica.
McCulloch J; Frymoyer J; Steurer P; Riaz G; Hurst F
Journal of spinal disorders
1993
1993-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00002517-199306050-00010" target="_blank" rel="noreferrer noopener">10.1097/00002517-199306050-00010</a>
Intestine farnesoid X receptor agonist and the gut microbiota activate G-protein bile acid receptor-1 signaling to improve metabolism.
Male; Animals; Mice; Random Allocation; Sensitivity and Specificity; *Signal Transduction; Lipid Metabolism; Bile Acids and Salts/*metabolism; GTP-Binding Proteins/*metabolism; Receptors; Inbred C57BL; Animal; Disease Models; G-Protein-Coupled/*metabolism; Gastrointestinal Microbiome/*drug effects; Glucagon-Like Peptide 1/metabolism; Cytoplasmic and Nuclear/*antagonists & inhibitors/pharmacology
Bile acids activate farnesoid X receptor (FXR) and G protein-coupled bile acid receptor-1 (aka Takeda G protein-coupled receptor-5 [TGR5]) to regulate bile acid metabolism and glucose and insulin sensitivity. FXR and TGR5 are coexpressed in the enteroendocrine L cells, but their roles in integrated regulation of metabolism are not completely understood. We reported recently that activation of FXR induces TGR5 to stimulate glucagon-like peptide-1 (GLP-1) secretion to improve insulin sensitivity and hepatic metabolism. In this study, we used the intestine-restricted FXR agonist fexaramine (FEX) to study the effect of activation of intestinal FXR on the gut microbiome, bile acid metabolism, and FXR and TGR5 signaling. The current study revealed that FEX markedly increased taurolithocholic acid, increased secretion of fibroblast growth factors 15 and 21 and GLP-1, improved insulin and glucose tolerance, and promoted white adipose tissue browning in mice. Analysis of 16S ribosomal RNA sequences of the gut microbiome identified the FEX-induced and lithocholic acid-producing bacteria Acetatifactor and Bacteroides. Antibiotic treatment completely reversed the
Pathak Preeti; Xie Cen; Nichols Robert G; Ferrell Jessica M; Boehme Shannon; Krausz Kristopher W; Patterson Andrew D; Gonzalez Frank J; Chiang John Y L
Hepatology (Baltimore, Md.)
2018
2018-10
<a href="http://doi.org/10.1002/hep.29857" target="_blank" rel="noreferrer noopener">10.1002/hep.29857</a>
Use of procalcitonin for the prediction and treatment of acute bacterial infection in children.
Anti-Bacterial Agents/*administration & dosage; Antibiotics – Administration and Dosage; Bacteremia – Blood; Bacteremia – Diagnosis; Bacteremia/blood/diagnosis; Bacterial Infections – Blood; Bacterial Infections – Diagnosis; Bacterial Infections – Drug Therapy; Bacterial Infections/blood/*diagnosis/drug therapy; Biological Markers – Blood; Biomarkers/blood; Calcitonin – Blood; Calcitonin Gene-Related Peptide; Calcitonin/*blood; Child; Humans; Inflammation – Blood; Inflammation – Diagnosis; Inflammation/blood/diagnosis; Predictive Value of Tests; Preschool; Prognosis; Protein Precursors – Blood; Protein Precursors/*blood; Sensitivity and Specificity
PURPOSE OF REVIEW: Procalcitonin (PCT) is increasingly utilized to determine the presence of infection or to guide antibiotic therapy. This review will highlight the diagnostic and prognostic utility of serum PCT in children. RECENT FINDINGS: Recent studies endorse the use of serum PCT to detect invasive infection, to differentiate sepsis from noninfectious systemic inflammatory response syndrome, and to guide antibiotic therapy. Typical values for maximal sensitivity and specificity are less than 0.5 ng/ml for noninfectious inflammation and greater than 2.0 ng/ml for bacterial sepsis. PCT appears to be a reliable indicator of infection. PCT has performed better than C-reactive protein in some settings, though pediatric comparative data are lacking. PCT may aid in diagnosing infection in challenging patient populations such as those with sickle cell disease, congenital heart defects, neutropenia, and indwelling central venous catheters. Antibiotic therapy tailored to serial PCT measurements may shorten the antibiotic exposure without increasing treatment failure. SUMMARY: PCT is a reliable serum marker for determining the presence or absence of invasive bacterial infection and response to antibiotic therapy. Tailoring antibiotics to PCT levels may reduce the duration of therapy without increasing treatment failure, but more research is needed in children.
Pierce Richard; Bigham Michael T; Giuliano John S Jr
Current opinion in pediatrics
2014
2014-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MOP.0000000000000092" target="_blank" rel="noreferrer noopener">10.1097/MOP.0000000000000092</a>
Inflammatory sacroiliac joint pathology: evaluation of radiologic assessment techniques.
Humans; Sensitivity and Specificity; False Positive Reactions; Tomography; Osteoarthritis/diagnosis/diagnostic imaging/*pathology; Sacroiliac Joint/*diagnostic imaging/*pathology; X-Ray Computed; X-Ray
Recognition of sacroiliac disease has been integral to arthritis diagnostic approaches. However, intra- and inter-observer variation have been recognized as limiting factors in radiologic assessment of the sacroiliac joint. The assumption that such irregularly shaped joints can be radiologically assessed of the sacroiliac joint. The assumption that such irregularly shaped joints can be radiologically assessed has not actually been rigorously evaluated. Direct arthroscopic visualization of the joints was therefore used as a standard against which to assess the validity of routine radiologic views, stereo-radiology, tomography and computed tomography, in the analysis of a group of sacroiliac joints drawn from the Todd Collection (Cleveland Museum of Natural History). The most sensitive techniques for the recognition of erosions or fusion are 15 degree angulation and stereo, but the frequency of false positives makes the technique of questionable clinical utility. While sensitivity for joint space narrowing is high with several techniques (30 degree anterior-posterior or posterior-anterior projections and tomograms), specificity is still poor, with a high rate of false positives. Fulfillment of the New York Criteria for sacroiliac disease is especially insensitive and non-specific. Radiologic techniques therefore have major limitations for the assessment of sacroiliac disease and greater reliance on clinical acumen is required for patient categorization.
Rothschild B M; Poteat G B; Williams E; Crawford W L
Clinical and experimental rheumatology
1994
1994-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Temporal artery temperature measurements in healthy infants, children, and adolescents.
Adolescent; Body Temperature/*physiology; Child; Cohort Studies; Confidence Intervals; Female; Humans; Infant; Male; Newborn; Preschool; Reference Values; Sensitivity and Specificity; Skin Temperature/physiology; Temporal Arteries; Thermometers/*standards
A noninvasive temporal artery thermometer that uses arterial heat balance technology has been compared to rectal and ear thermometry and is available in the marketplace. This study was undertaken to establish mean temperatures and temperatures 2 standard deviations above the mean for healthy infants, children, and adolescents. Temperatures were measured in healthy patients 0 to 18 years of age using a noninvasive temporal artery thermometer. Temperatures were measured in 2,346 patients. Mean temperatures and temperatures 2 standard deviations above the mean were: 37.1 degrees C (38.1 degrees C) for 383 infants 0 to 2 months; 36.9 degrees C (37.9 degrees C) for 860 children 3 to 47 months; 36.8 degrees C (37.8 degrees C) for 680 children 4 to 9 years; and 36.7 degrees C (37.8 degrees C) for 423 adolescents 10 to 18 years. There were no significant differences in temperatures in white compared to African-American children, children with or without perspiration on their forehead, or between measurements taken on the left compared to the right side of the forehead. This study provides information about temporal artery temperatures in healthy infants and children that can serve as a basis for interpreting temperature measurements in ill children when the same instrument is used.
Roy Sumita; Powell Keith; Gerson Lowell W
Clinical pediatrics
2003
2003-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/000992280304200508" target="_blank" rel="noreferrer noopener">10.1177/000992280304200508</a>
Raising concerns about the Sepsis-3 definitions.
*Data Accuracy; *Infections; *Organ dysfunction; *Sepsis; *Septic shock; *Severity of Illness Index; Arterial Pressure; Consensus; Glasgow Coma Scale; Humans; Infection; Organ Dysfunction Scores; Publishing; Sensitivity and Specificity; Sepsis; Sepsis/*classification/mortality; Validation Studies
The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.
Sartelli Massimo; Kluger Yoram; Ansaloni Luca; Hardcastle Timothy C; Rello Jordi; Watkins Richard R; Bassetti Matteo; Giamarellou Eleni; Coccolini Federico; Abu-Zidan Fikri M; Adesunkanmi Abdulrashid K; Augustin Goran; Baiocchi Gian L; Bala Miklosh; Baraket Oussema; Beltran Marcelo A; Jusoh Asri Che; Demetrashvili Zaza; De Simone Belinda; de Souza Hamilton P; Cui Yunfeng; Davies R Justin; Dhingra Sameer; Diaz Jose J; Di Saverio Salomone; Dogjani Agron; Elmangory Mutasim M; Enani Mushira A; Ferrada Paula; Fraga Gustavo P; Frattima Sabrina; Ghnnam Wagih; Gomes Carlos A; Kanj Souha S; Karamarkovic Aleksandar; Kenig Jakub; Khamis Faryal; Khokha Vladimir; Koike Kaoru; Kok Kenneth Y Y; Isik Arda; Labricciosa Francesco M; Latifi Rifat; Lee Jae G; Litvin Andrey; Machain Gustavo M; Manzano-Nunez Ramiro; Major Piotr; Marwah Sanjay; McFarlane Michael; Memish Ziad A; Mesina Cristian; Moore Ernest E; Moore Frederick A; Naidoo Noel; Negoi Ionut; Ofori-Asenso Richard; Olaoye Iyiade; Ordonez Carlos A; Ouadii Mouaqit; Paolillo Ciro; Picetti Edoardo; Pintar Tadeja; Ponce-de-Leon Alfredo; Pupelis Guntars; Reis Tarcisio; Sakakushev Boris; Kafil Hossein Samadi; Sato Norio; Shah Jay N; Siribumrungwong Boonying; Talving Peep; Trana Cristian; Ulrych Jan; Yuan Kuo-Ching; Catena Fausto
World journal of emergency surgery : WJES
2018
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1186/s13017-018-0165-6" target="_blank" rel="noreferrer noopener">10.1186/s13017-018-0165-6</a>
Recognition of depression by internal medicine residents.
*Internal Medicine; *Internship and Residency; 80 and over; Adolescent; Adult; Aged; Depression/*diagnosis/epidemiology; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Psychological Tests; Regression Analysis; Risk Factors; Sensitivity and Specificity
We studied the ability of internal medicine residents to recognize depressive symptoms in a population of lower socio-economic primary care patients. Four hundred twenty patients completed the short form of the Beck Depression Inventory (BDI). Simultaneously, the resident caring for the patient estimated the degree of depression for each patient. One-fourth of the patients scored at or above the moderately depressed level on the BDI and the residents rated 23 percent of their patients as at least moderately depressed. However, the accuracy of the residents' assessment of his or her individual patient was poor (correlation = 0.42, sensitivity = 0.46, specificity = 0.84). Patients with a prior history of psychiatric disorder scored higher on the BDI and were given higher ratings of depression. No other pre-existing medical condition was significantly associated with a higher or lower BDI score. The amount of alcohol consumed and the amount smoked, were both associated with higher BDI scores. Residents varied in their sensitivity to their patients' BDI scores. Some showed high agreement with BDI scores, others low. There were no specific resident characteristics (e.g. year of training, resident gender) that could explain this variability. Patients with a history of depression were given lower resident ratings compared to other patients and patients with a history of depression were given lower resident ratings than predicted by their BDI scores. Residents' ability to accurately diagnose and treat depression in the underprivileged primary care patient can be facilitated by the institution of depression screening in the ambulatory clinic.
Sliman R J; Donohue T A; Jarjoura D; Ognibene A J
Journal of community health
1992
1992-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/bf01324403" target="_blank" rel="noreferrer noopener">10.1007/bf01324403</a>
Sonoelastography of Breast Lymphoma.
80 and over; 80 and Over; Aged; Breast; Breast Neoplasms; Breast Neoplasms/*diagnostic imaging; Breast/diagnostic imaging; Diagnosis; Differential; Elasticity Imaging Techniques/*methods; Female; Humans; Lymphoma; Lymphoma/*diagnostic imaging; Male; Mammary/*methods; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Ultrasonography; Ultrasonography – Methods
Breast lymphomas only account for approximately 0.15% of malignant breast carcinomas. Half of these are primary lymphomas, and the other half are metastatic to the breast. Ultrasound elastography has been proven to aid in the diagnosis of breast lesions as malignant or benign, with malignancy appearing stiffer compared with normal breast tissue. However, in this study, we review the findings of breast lymphoma on strain and shear wave ultrasonography. Lymphoma appears drastically different on sonoelastography than primary breast cancers, and it could easily be interpreted as benign. Therefore, the unique imaging findings in addition to the patient's clinical history are important in differentiating lymphoma of the breast from other possible diagnoses.
Sousaris Nicholas; Barr Richard G
Ultrasound quarterly
2016
2016-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/RUQ.0000000000000213" target="_blank" rel="noreferrer noopener">10.1097/RUQ.0000000000000213</a>
Sonographic Elastography of Mastitis.
Adult; Female; Humans; Middle Aged; Aged; Retrospective Studies; Ultrasonography; Sensitivity and Specificity; breast; breast ultrasound; Breast/diagnostic imaging; Elasticity Imaging Techniques/*methods; elastography; mastitis; Mastitis/*diagnostic imaging; shear wave elastography; strain elastography; Diagnosis; Differential; Computer-Assisted; Image Interpretation; Mammary/*methods
Sonographic elastography has been shown to be a useful imaging modality in characterizing breast lesions as benign or malignant. However, in preliminary research, mastitis has given false-positive findings on both strain and shear wave elastography. In this article, we review the findings in mastitis with and without abscess formation on both strain and shear wave elastography. The elastographic findings in all cases were suggestive of a malignancy according to published thresholds. In cases of mastitis with abscess formation, there is a characteristic appearance, with a central very soft area (abscess cavity) and a very stiff outer rim (edema and inflammation). This appearance should raise the suspicion of mastitis with abscess formation, since these findings are rare in breast cancers.
Sousaris Nicholas; Barr Richard G
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
2016
2016-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.7863/ultra.15.09041" target="_blank" rel="noreferrer noopener">10.7863/ultra.15.09041</a>
Predictors of nonattendance at the first newborn health supervision visit.
Adult; Female; Ohio; Socioeconomic Factors; Infant; Risk Factors; Sensitivity and Specificity; Age Factors; Outpatients; Hospitals; Patient Compliance; Appointments and Schedules; Confidence Intervals; Mothers; Human; Chi Square Test; Funding Source; Logistic Regression; Newborn; Models; Statistical; Record Review; Telephone; Predictive Research; Relative Risk; Adolescent Mothers; Infant Care; Marital Status; Maternal Age; Parity; Pediatric – Ohio; Ambulatory Care Facilities – Utilization; Child Health Services – Utilization; Physical Examination – In Infancy and Childhood
Specht E M; Bourguet C C
Clinical pediatrics
1994
1994-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/000992289403300504" target="_blank" rel="noreferrer noopener">10.1177/000992289403300504</a>
Aeroallergen sensitization in healthy children: racial and socioeconomic correlates.
Female; Male; Socioeconomic Factors; Incidence; Child; Risk Factors; Sensitivity and Specificity; Odds Ratio; Health Status; Probability; Confidence Intervals; Human; Adolescence; Logistic Regression; Case Control Studies; Immunization; Preschool; Population; Air Pollutants – Immunology; Allergens – Immunology; Hypersensitivity – Diagnosis; Hypersensitivity – Epidemiology; Hypersensitivity – Immunology; Respiratory Hypersensitivity – Diagnosis; Respiratory Hypersensitivity – Ethnology; Respiratory Hypersensitivity – Immunology; Skin Tests – Methods
Objective: Allergic sensitization is very prevalent and often precedes the development of allergic disease. This study examined the association of race with allergic sensitization among healthy children with no family history of atopy.Study Design: Two hundred seventy-five children, predominantly from lower socioeconomic strata, from Cincinnati, Ohio, ages 2 to 18 years without a family or personal history of allergic diseases, underwent skin prick testing to 11 allergen panels. The Pediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) was used to examine the impact of sensitization on quality of life.Results: Thirty-nine percent of healthy children were sensitized to 1 or more allergen panels. Multivariate logistic regression showed increased risk among African-American children for any sensitization (OR, 2.17; [95% CI: 1.23, 3.84]) and sensitization to any outdoor allergen (OR, 2.96 [95% CI: 1.52, 5.74]). Eighty-six percent of children had PADQLQ scores of 1 or less (0 to 6 scale).Conclusions: Allergic sensitization is prevalent even among children who do not have a personal or family history of asthma, allergic rhinitis, or atopic dermatitis and who have no evidence of current, even subtle effects from this sensitization on allergic disease-related quality of life. African-American children are at greater risk for presence of sensitization, especially to outdoor allergens.
Stevenson MD; Sellins S; Grube E; Schroer K; Gupta J; Wang N; Khurana Hershey GK; Stevenson Michelle D; Sellins Stacey; Grube Emilie; Schroer Kathy; Gupta Jayanta; Wang Ning; Khurana Hershey Gurjit K
Journal of Pediatrics
2007
2007-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jpeds.2007.03.001" target="_blank" rel="noreferrer noopener">10.1016/j.jpeds.2007.03.001</a>
Crystal Diagnostics Xpress() LM Kit for the Rapid Detection of Listeria monocytogenes from Environmental Surfaces.
Sensitivity and Specificity; Ceramics; Listeria monocytogenes/*isolation & purification; Plastics; Stainless Steel; *Reagent Kits; Diagnostic
The Crystal Diagnostics (CDx) Xpress LM kit is used for rapid screening of low concentrations of Listeria monocytogenes on environmental surfaces such as stainless steel, plastic, and ceramic tile. In addition to the Xpress LM kit, the CDx Xpress System comprises an automatic Xpress Reader, a BioCassette that incorporates antibody-coupled microspheres, and liquid crystal for selective identification of the intended microbe. All 56 of the 56 tested L. monocytogenes strains evaluated were detected, and 50 of the 50 nontarget bacterial strains were excluded when the test was conducted under the described kit conditions. Shelf-life testing of the antibody-coated microspheres and other CDx consumables indicated that all materials were stable for a minimum of 6 months (ongoing), and lot-to-lot testing demonstrated no significant differences among lots. The internal and independent laboratory tests on stainless steel, plastic, and ceramic tile surfaces demonstrated that the method is equivalent to the U.S. Department of Agriculture (USDA) reference method, and there were no significant differences between the CDx Xpress LM kit presumptive and confirmed results for any of the matrixes. Overall, the CDx Xpress LM kit is one of the fastest to provide the sensitivity and specificity equivalent to the USDA reference method in screening low levels of L. monocytogenes surface contamination and, when combined with chromogenic culturing of presumptive positives, provides a streamlined confirmation process to rapidly and accurately differentiate L. monocytogenes from other microbes.
Stumpf Curtis H; Bullard Brian; Zhoa Weidong; Kuzenko-Hentosh Stephanie; Niehaus Gary D
Journal of AOAC International
2017
2017-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.5740/jaoacint.16-0300" target="_blank" rel="noreferrer noopener">10.5740/jaoacint.16-0300</a>
Evaluation and use of a rapid Staphylococcus aureus assay by an antimicrobial stewardship program.
Humans; Time Factors; Microbial Sensitivity Tests; Sensitivity and Specificity; Prospective Studies; Hospitals; Anti-Bacterial Agents/administration & dosage/*pharmacology; Bacteriological Techniques; False Negative Reactions; Methicillin-Resistant Staphylococcus aureus/*isolation & purification; Staphylococcal Infections/*diagnosis/microbiology; Staphylococcus aureus/*isolation & purification; Cell Culture Techniques; Chromatography; Human; Funding Source; Community; Affinity; Observational Methods; Biological Assay – Methods; Methicillin-Resistant Staphylococcus Aureus – Analysis
PURPOSE: The performance of a rapid test for methicillin-resistant Staphylococcus aureus (MRSA) in a large community hospital was investigated. METHODS: A prospective observational study was conducted to evaluate an immunochromatographic assay (Alere PBP2a Culture Colony Test, Alere Scarborough, Inc.) for rapid differentiation of MRSA and methicillin-susceptible S. aureus (MSSA) strains using isolates cultured overnight on common laboratory media. S. aureus isolates cultured for 12-24 hours were tested with the assay, which detects penicillin-binding protein 2a (PBP2a) and provides results in six minutes. The test results were compared with data from standard overnight antimicrobial susceptibility testing to determine the assay's sensitivity and specificity. Changes in therapy associated with use of the rapid assay were evaluated. RESULTS: Over an 11-month period, 661 inpatient isolates from mostly nonhematologic sites were tested. There were six false-negative results, indicating assay sensitivity of 98.4%, with no false positives (specificity of 100%). Eight invalid test results were documented. During designated evaluation periods, a total of 169 patient cases involving PBP2a testing were reviewed by the hospital's antimicrobial stewardship pharmacist. In 63 of those cases (37%), changes in therapy were implemented on the day of test result posting. Interventions often involved switching patients from inappropriate to appropriate MRSA therapy or optimizing MRSA- or MSSA-targeted therapy. CONCLUSION: An assay for quickly differentiating between MRSA and MSSA was highly sensitive, highly specific, and inexpensive in actual hospital use and led to rapid prescription of appropriate antistaphylococcal therapy 24-48 hours after culture specimens were collected.
Trienski Tamara L; Barrett Heather L; Pasquale Timothy R; DiPersio Joseph R; File Thomas M Jr
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
2013
2013-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2146/ajhp130118" target="_blank" rel="noreferrer noopener">10.2146/ajhp130118</a>
Streptococcus pneumoniae antimicrobial susceptibility testing.
*Drug Resistance; Anti-Bacterial Agents/*pharmacology; Child; Humans; Infant; Microbial; Microbial Sensitivity Tests/*methods; Preschool; Sensitivity and Specificity; Streptococcus pneumoniae/*drug effects/isolation & purification
Venglarcik J S 3rd
The Pediatric infectious disease journal
2000
2000-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00006454-200004000-00013" target="_blank" rel="noreferrer noopener">10.1097/00006454-200004000-00013</a>
[Commentary on] Positive emission tomography for evaluating a complete clinical response in patients with ovarian or peritoneal carcinoma: correlation with second-look laparotomy.
Female; Sensitivity and Specificity; Tomography; Laparotomy; Emission-Computed; Ovarian Neoplasms – Diagnosis; Peritoneal Neoplasms – Diagnosis
von Gruenigen V E
Women's Oncology Review
2002
2002-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Importance of Culture for Group A Strep Pharyngitis after a Negative Rapid Test.
Adult; Incidence; Sensitivity and Specificity; Medical Records; Multicenter Studies; Adolescence; Retrospective Design; Washington; Diagnosis; Differential; Microbial Culture and Sensitivity Tests; Patient Care – Standards; Pharyngitis – Etiology; Streptococcal Infections – Complications; Streptococcal Infections – Diagnosis
Watkins Richard R
Infectious Disease Alert
2014
2014-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Reclining chairs reduce pain from gurneys in older emergency department patients: a randomized controlled trial.
Ohio; Aged; Sensitivity and Specificity; Prospective Studies; Pain Measurement; Patient Satisfaction; Outpatients; Hospitals; Self Report; Confidence Intervals; Human; Descriptive Statistics; Funding Source; Scales; Data Analysis Software; Surveys; Coefficient Alpha; Summated Rating Scaling; Emergency Service; Community; Treatment Outcomes; Emergency Patients; Beds and Mattresses; Interior Design and Furnishings; Patient Positioning; Single-Blind Studies; 80 and Over; Pain – Prevention and Control – In Old Age
OBJECTIVES: Pain related to the gurney is a frequent complaint of older emergency department (ED) patients. The authors hypothesized that these patients may have less pain and higher satisfaction if allowed to sit in a reclining hospital chair. METHODS: A single-blind, randomized controlled trial was performed. Patients 65 years old or older who were able to sit upright, transfer, and engage in normal conversation were eligible. Severely ill or cognitively impaired patients were excluded. Patients were randomized to either remain on the gurney or transfer to the chair after initial evaluation. Patients reported pain at arrival (t0), at one hour (t1), and at two hours (t2) using a 0-10 pain scale, and satisfaction at study completion on a 0-10 scale. The primary outcome was a decrease in pain between t0 and t1 or no pain at both t0 and t1. This outcome was analyzed using a 95% confidence interval for the difference between proportions; exclusion of zero was considered significant. RESULTS: Sixty-six patients in each group were enrolled. There was no difference in demographics between groups, but the chair patients were more likely to have pain at t0 than the gurney patients. More chair patients than gurney patients had a successful primary outcome (97% vs. 76%, 21% difference, 95% CI=10% to 32%). The mean satisfaction score was higher in the chair group than in the gurney group (8.1 vs. 6.0, 2.1 difference, 95% CI=1.4% to 2.8%). CONCLUSIONS: The simple modification of allowing older ED patients to sit in reclining chairs resulted in less pain and higher satisfaction.
Wilber S T; Burger B; Gerson L W; Blanda M
Academic Emergency Medicine
2005
2005-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2005.tb00846.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2005.tb00846.x</a>