Microlaparoscopy: a comparative study of diagnostic accuracy

OBJECTIVE: To investigate the diagnostic accuracy of microlaparoscopy in comparison to laparoscopy with a standard 10-mm laparoscope. DESIGN: Prospective evaluation by two independent observers. SETTING: Academic Medical Center. PATIENT(S): Ten patients scheduled to undergo diagnostic laparoscopy for the indications of infertility and/or chronic pelvic pain. INTERVENTION(S): Two surgeons were present for each operation. Diagnostic laparoscopy was performed using the Microlap 2-mm laparoscope (Imagyn Medical Inc., Lagun Niguel, CA). Standard diagnostic laparoscopy was then performed using a 10-mm laparoscope. After each procedure, each surgeon reported his or her observations in a confidential manner to a third person to record. MAIN OUTCOME MEASURE(S): Endometriosis and adnexal adhesions were staged. Observations made with the microlaparoscope were compared with those obtained with a standard 10-mm laparoscope for each surgeon. The observations of both surgeons were also compared with each other's to evaluate interobserver differences. RESULT(S): Operative findings reported by each individual surgeon using the microlaparoscope correlated with the operative findings reported using the larger laparoscope. Scores for both endometriosis and adnexal adhesions did not differ in any significant way. Endometriosis scores differed by no more than 6 points, and adhesion scores differed by no more than 2 points, with no subsequent change in severity classification for either finding. Furthermore, when comparing the additional operative findings of the two surgeons, no difference was noted when using either the microlaparoscope or a standard 10-mm laparoscope. CONCLUSION(S): The diagnostic accuracy achieved with microlaparoscopy is comparable to that achieved with standard 10-mm laparoscopy.     

A test–retest reliability study of the Wechsler Adult Intelligence Scale.

The WAIS is one of the most widely used means for assessing intelligence, yet data on test–retest reliability are scarce. The test–retest IQs of 50 psychiatric patients (mean age 44 yrs) were correlated. The patients were not from any specific diagnostic group. They were included in the sample only because they had been given the WAIS before. The interval between test and retest averaged almost 2 yrs. All test–retest correlations were .90 or over. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A novel approach to improve the computing accuracy of rolling force and forward slip

In cold strip rolling control system, rolling force and forward slip are the prerequisites for the model setting calculation, and the deformation resistance and friction coefficient are the main parameters that affect their predictions. A new method based on objective function is first proposed in this paper to improve the calculation accuracy of rolling force and forward slip, and the deformation resistance and friction coefficient are taken as optimisation variables. Using the multi-population co-evolutionary algorithm to solve the objective function, the required rolling force and forward slip are obtained. The pre-set values of rolling force and roller line speed are compared with the actual measured ones in a 1450?mm five-stand tandem cold mill and other researcher’s method. Results show that the calculated values are in fair agreements with the on-line measured ones, and the thickness and flatness accuracy of the final product are improved.     

Assessment of International Headache Society diagnostic criteria: a reliability study

In 1988 the International Headache Society (IHS) introduced new diagnostic criteria for headaches and craniofacial pain. Since headaches can be diagnosed solely on the basis of information provided by the patient, it is essential that the criteria are reproducible and consistent. Two neurologists evaluated the clinical records of 100 consecutive outpatients and transferred the data on headache and associated phenomena to a form designed to reflect the IHS criteria. Interobserver concordance (kappa statistics) in the application of the diagnostic criteria of primary headaches was: (i) "perfect" to "substantial" for the first IHS digit, being kappa = 1.0 for cluster headache and paroxysmal hemicrania; kappa = 0.88 for migraine; kappa = 0.75 for tension-type headache; (ii) "almost perfect" to "substantial" for the second digit (kappa = 0.94 for cluster headache; kappa = 0.90 for migraine with aura; kappa = 0.81 for episodic tension-type headache; kappa = 0.78 for migraine without aura; kappa = 0.71 for chronic tension-type headache; kappa = 0.66 for cluster headache-like disorder not fulfilling the criteria; (iii) "moderate" for migrainous disorder (kappa = 0.48) and headache of the tension-type (kappa = 0.43) not fulfilling the criteria. These results show that the IHS diagnostic criteria are satisfactorily applicable to high quality medical records abstracted by experienced neurologists.     

Cut-off point of the Scoliometer in school scoliosis screening

STUDY DESIGN: A large-scale study on school screening for scoliosis was conducted to assess the referral rate, prevalence rate, and positive predictive value using different angles of trunk rotation as criteria for referral. OBJECTIVE: To determine an ideal angle of trunk rotation cut-off point to be used for referral in school screening for scoliosis. SUMMARY OF BACKGROUND DATA: When using the Scoliometer (Orthopedic Systems, Inc., Hayward, CA) in school scoliosis screening, 5 degrees and 7 degrees angles of trunk rotation have been recommended as criteria for referral. Low positive predictive values and over-referral at these levels have been reported. METHODS: The Adams forward bend test and Scoliometer measurement were combined for school scoliosis screening in 33,596 girls from the fifth, sixth and seventh grades. Nurses were the primary screeners. Girls with trunk rotation angles of 5 degrees or more were referred for radiography. RESULTS: The referral rate was 5.2%. By selecting 6 degrees, 7 degrees, 8 degrees, 9 degrees or 10 degrees angles of trunk rotation as criteria for referral, the referral rate became 2.4%, 1.4%, 0.7%, 0.5%, or 0.3%, respectively. The prevalence rate for scoliosis equal to or larger than 10 degrees, 20 degrees, 30 degrees, or 40 degrees of the Cobb angle was 1.47%, 0.21%, 0.04% and 0.02%, respectively, by using a 5 degrees angle of trunk rotation as the criterion for radiography. The positive predictive value was 28.3% for scoliosis of 10 degrees or more, 4% for scoliosis of 20 degrees or more, 0.8% for scoliosis of 30 degrees or more, and 0.4% for scoliosis of 40 degrees or more with a 5 degrees angle of trunk rotation as the criterion for referral. By selecting angles of trunk rotation larger than 5 degrees as criteria for referral for radiography, the positive predictive value increased, but positive cases with larger Cobb angles also decreased markedly. CONCLUSION: The optimal cut-off point for referral when using the Scoliometer in school screening of scoliosis is still difficult to determine.     

Optimization and diagnostic accuracy of computerized tomography with tridimensional spiral technique in the study of craniostenosis

INTRODUCTION: Conventional Computed Tomography (CT) with three-dimensional (3D) reconstructions is considered the most complete and accurate imaging modality to diagnose craniosynostosis. However, the introduction of Spiral CT (SCT) opened new possibilities for 3D studies of the skull in pediatric patients with craniosynostosis. The purpose of our study is two fold: first, to optimize the scanning and imaging parameters to obtain diagnostic images in a single spiral scan; second, to assess the diagnostic accuracy of such images in the identification of normal and abnormal cranial vault sutures. MATERIAL AND METHODS: Seventy-eight pediatric patients (age range: 1-35 months; mean: 11.8 months) with craniosynostosis were submitted to SCT of the head. The images were acquired with the following parameters: 3- and 5-mm nominal slice thickness, 5-6 mm/s table feed (pitch 1-2), 165 mAs and 120 kV. Two different algorithms and increases were used for image reconstructions. A first set of images was reconstructed with 2-mm increases and a soft tissue algorithm: these images were used for brain studies and for 3D reconstructions. A second set of slices was reconstructed with 5-mm increases and a bone algorithm to visualize the sutures of the axial plane. The 3D images were processed with the Shaded Surface Display software with threshold values ranging 120-150 HU. All images were acquired with a single spiral scan lasting less than 30 seconds. Two blinded radiologists analyzed the 3D and the planar images independently to evaluate the course and depth of each cranial suture. The sensitivity, specificity and diagnostic accuracy of both 3D and planar SCT images were evaluated. The frequency of artifacts (the Lego effect, boiled egg, pseudoforamina, movement, and chainsaw artifacts) and their influence on the final diagnosis were studied on 3D SCT images. RESULTS: The diagnostic accuracy rates of 3D SCT images, by suture, were: sagittal 90.7%, metopic 100%, left lamboid 90.9%, right lamboid 93.9%, left coronal 85.7%, right coronal 91.1%. The diagnostic accuracy rates of the axial images, by suture, were: sagittal 90.7%, metopic 95.5%, left lamboid 86.4%, right lamboid 90.9%, left coronal 83.7%, right coronal 91.1%. The interobserver agreement on 3D images was: sagittal 91.1%, metopic 100%, left lamboid 88.9%, right lamboid 91.1%, left coronal 88.9%, right coronal 84.4%. The Lego effect artifact was the most frequent one (82%) and affected image evaluation in 6.3% of cases. CONCLUSIONS: Our results prove that 3D SCT is a very accurate technique for identifying normal and abnormal sutures and presents many advantages over conventional 3D CT in the examination of pediatric patients with craniosynostosis. The quality of 3D SCT images was adequate and the artifacts did not affect the final diagnostic yield significantly.     

Providing patients with their diagnostic test results. A vignette study in general practice

The communication of results of HIV tests and chest-X-rays because of persistent coughing are of particular interest because potential life-threatening disease may be disclosed. For HIV tests it is recommended that the result is communicated to the patient in the doctor's office face to face. In this questionnaire study based on two simulated case-stories with a 63 year-old man referred to chest-X-rays because of persistent coughing, and a 27 year-old man, who had been living in Africa for some time, now wanting a HIV test performed, we found that only half (53%) of the general practitioners (GP) did communicate HIV test results in the consultation office. X-ray test results were only communicated in the consultation office by 18% of the GPs. Communication of test results which might have serious implications to the patient should preferably not be done by telephone. Patients should be told of potentially serious results in person by their own physician.     

Factors influencing the diagnostic accuracy of dobutamine stress echocardiography

Genes underlie numerous human diseases and traits. Although we have witnessed a great deal of success in identifying disease-susceptible genes, the task remains challenging for most of the complex diseases. This paper reviews evidence for the role of genetic factors in complex diseases including breast cancer, diabetes and multiple sclerosis. We then describe strategies that can potentially optimize our chance of success in identifying genes involved in complex diseases. Advances in molecular biology, particularly mapping of the human genome, statistical methods that provide more accurate models of complex patterns of inheritance, and basic medical science, which have increased our understanding of disease pathophysiology, will ultimately strengthen the ability of the current generation of genetic epidemiological studies to identify the genetic basis of complex human disorders.     

Methods to improve the diagnostic accuracy of malignant mesothelioma

Longitudinal study taken up for one year in 10 different types of breeding habitats in Dindigul town, Tamil Nadu, revealed that out of 51,785 habitats 225 (0.43%) were found positive for Anopheles stephensi immatures. The overall positivity varied between 0.03 to 1.31% with peak density during July. The observed habitat-wise positivity was overhead tanks 0-7.07%; wells 0-1.69%; under ground tanks 0-2.26%; tappits 0-2.36%; outside tanks (permanent) 0-2.42%; outside tanks (temporary) 0-0.39%; inside tanks (permanent) 0-2.0%; inside tanks (temporary) 0-3.6%; barrels 0-1.32% and others 0-25.0%. In 16.0% habitats An. stephensi was found breeding with An. subpictus, Aedes aegypti, Ae. vittatus and Culex quinquefasciatus in different combinations. Overhead tanks were found to contribute maximum An. Stephensi breeding in this area.     

A biomechanical study of balance recovery during the fall forward

The study deals with the biomechanics of balance recovery of human subjects in a falling forward situation. Eight subjects took part in the experiment. The subject, held in the initial leaning forward position, was released without his knowledge. The instruction was to recover the induced disequilibrium by walking. The biomechanical analysis shows two phases in the balance recovery. The first phase--preparation phase--is characterized by three events at fixed timing whatever the initial inclination. (i) Dynamic reaction time, showing no significant inter-individual variation (mean value = 90.8 ms). (ii) Braking of the forward fall, between 184 ms and 237.2 ms, depending on the subject. (iii) Beginning of the swing phase--i.e. toe-off instant--between 235.9 ms and 328.3 ms, depending on the subject. The second phase--gait execution phase--is characterized by the duration of the swing phase, the duration of the stance phase, the stride length and execution speed. The durations diminish whereas the stride length and the execution speed increase with respect to the initial inclination. For the same execution speed, the stride length is shorter than in normal walking. It has been concluded that balance recovery following an induced fall forward begins with an invariable preparation process which is followed by an adaptable recovery one.     

The Pyloritek test and the CLO test: accuracy and incremental cost analysis

Malpractice lawsuits affect most physicians at some point in their career. Proving that malpractice has been committed is based on substantiation of a variety of elements, including that the patient was rendered care that was "below the standard" of care. While many physicians believe that the "standard" will be judged objectively on the basis of published scientific sources and accepted conventions, the standard is established rather by the testimony of expert witness(es). It is the expert testimony that sets the standard and is proof of the standard. The testimony is open for acceptance or rejection by the judge or jury for a variety of nonscientific reasons. We review what the defendant doctor might expect regarding proof required to establish breach of the standard of care and what the prudent expert should be obliged to demonstrate.     

Validity generalization and hypothetical reliability distributions: A test of the Schmidt-Hunter procedure.

A Monte Carlo study was conducted to determine how variations in true reliability distributions affect validity generalization estimates that are based on hypothetical reliability distributions proposed by Schmidt and Hunter. Both interactive and noninteractive validity generalization equations were examined. True reliability distributions and sample sizes were systematically varied. Depending on the sample size and nature of the true distributions, artifactual variance was either overestimated or underestimated by both equations. In some cases, extremely large errors were observed. Even when the data were generated with true reliability distributions identical to the hypothetical distributions, both equations systematically overestimated artifactual variance. The severity of estimation errors increased proportionally as sample size per validity coefficient increased. Implications of using assumed distributions and recommendations for validity generalization researchers are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of experience and training on diagnostic accuracy.

In this reexamination of a previously published report (R. Brammer, 1997), psychologists and psychology students (N = 138) were provided an artificial intelligence program that simulated a clinical interview. The "client" provided paragraph-length answers to the questions participants chose to ask. At the end of their interview, the participants provided a brief diagnosis for the client. A path analysis revealed that clinical experience is a strong predictor of the ability to form an accurate diagnosis and that an individual's level of training, mediated by the number of diagnostic questions asked, also helps to derive accurate diagnoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The reliability of the diagnostic features in patients with narcolepsy

This study determined the test-retest reliability of the polysomnographic findings in narcolepsy. The diagnosis of narcolepsy was based on clinical symptoms and polysomnographic signs. Control subjects were screened before participation and were split based on their screening multiple sleep latency test (MSLT) into high- and low-MSLT groups. Subjects completed two polysomnographic evaluations with at least 5 days between laboratory tests. Narcoleptics had lower sleep efficiencies and high stage 1% when compared to the low MSLT control group. They had more awakenings and less stage 2% than the control groups. Narcoleptics had a shorter latency to 1 when compared to the high-MSLT group but comparable to that of the low-MSLT group. Narcoleptics had a higher number of sleep-onset rapid eye movement periods (SOREMPs) than both control groups. The MSLT scores were stable across the two evaluations and showed a statistically significant correlation. Twenty-eight of the 30 narcoleptic subjects had two or more SOREMPs on reevaluation. None of the controls had multiple SOREMPs. Thus, multiple SOREMPs were shown to be a reliable finding in patients with narcolepsy.     

Clinican reliability and accuracy in judging appropriate level of care.

Accurately assigning children to the most appropriate level of care is widely recognized as important. Managed care companies conduct utilization reviews in which they monitor the level of care to which clients are assigned using written placement criteria. However, no research has examined the ability of clinicians to perform this task. In the present study, 47 child and adolescent clinical profiles consisting of 48 variables were developed. Eighteen clinicians, trained to use their agency's level of-care guidelines, made level-of-care decisions on these profiles. Their interjudge reliability in assigning a child to an appropriate level of care was close to zero (k?=?.07). There was a small, statistically significant correlation between client placement and actual placement, but chance-corrected agreement between client placement and actual placement was very low (k?=?.09 ) . Implications of these findings for clinical research, practice, policy, and training are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of the reliability of the Canada Fitness Survey questionnaire

PURPOSE: The purposes of this study are to assess the reliability of the physical activity components of the Canada Fitness Survey (CFS) questionnaire (N = 64 males, N = 63 females) and the Canadian Aerobic Fitness Test (N = 44 males, N = 52 females) in a sample of subjects between 15 and 80 yr. RESULTS: The intraclass correlation (rI) for the fitness scores was 0.98. The activity variables showed low to moderate correlations (rI = 0.48-0.53). Correlations were higher for males (rI = 0.38-0.65) than females (rI = 0.28-0.60) for most of the activity variables reported. Males generally report leisure activity more reliably than nonleisure activity, whereas the opposite was true for females. Males reported strenuous activity with higher reliability (rI = 0.86) than females (rI = 0.31). There was considerable variation in the reliability of specific activities. Of the components of physical activity (time, intensity, duration) that comprise the energy expenditure (EE) variable, the least reliably reported is intensity for both males (rI = 0.43) and females (rI = 0.55). CONCLUSIONS: The CFS questionnaire is moderately reliable for most measures of physical activity. Estimates of reliability vary considerably among the various activities and components of these activities and between males and females.     

Common dermatophyte infections. A simple diagnostic test and current management

Tinea pedis, onychomycosis, tinea cruris, and tinea capitis are among the most common dermatophyte infections and are seen in all socioeconomic groups. Successful treatment of these conditions depends first on accurate diagnosis, which is often quickly accomplished with a KOH examination. Culture may be needed in some cases, but results may not be available for 2 weeks or more. Immunocompromised patients are particularly susceptible to dermatophyte infection, and any deviations in presentation or failure to respond to treatment should prompt investigation for an underlying problem.