-
Diagnostics (Basel, Switzerland) May 2021The objective of this review was to compile validated functional shoulder assessment tools and analyse the methodological quality of their validations. Secondarily, we... (Review)
Review
The objective of this review was to compile validated functional shoulder assessment tools and analyse the methodological quality of their validations. Secondarily, we aimed to provide a comparison of the tools, including parameter descriptions, indications/applications, languages and operating instructions, to choose the most suitable for future clinical and research approaches. A systematic review (PRISMA) was conducted using: PubMed, WoS Scopus, CINHAL, Dialnet and reference lists until 2020. The main criteria for inclusion were that papers were original studies of validated tools or validation studies. Pre-established tables showed tools, validations, items/components, etc. The QUADAS-2 and COSMIN-RB were used to assess the methodological quality of validations. Ultimately, 85 studies were selected, 32 tools and 111 validations. Risk of bias scored lower than applicability, and patient selection got the best scores (QUADAS-2). Internal consistency had the highest quality and PROMs development the lowest (COSMIN-RB). Responsiveness was the most analysed metric property. Modified UCLA and SST obtained the highest quality in shoulder instability surgery, and SPADI in pain. The most approached topic was activities of daily living (81%). We compiled 32 validated functional shoulder assessment tools, and conducted an analysis of the methodological quality of 111 validations associated with them. Modified UCLA and SST showed the highest methodological quality in instability surgery and SPADI in pain.
PubMed: 34066777
DOI: 10.3390/diagnostics11050845 -
Therapeutics and Clinical Risk... 2023For the diagnosis of pediatric osteomyelitis, the sensitivity, specificity, and predictive value of erythrocyte sedimentation rate (ESR) were evaluated in this study. (Review)
Review
OBJECTIVE
For the diagnosis of pediatric osteomyelitis, the sensitivity, specificity, and predictive value of erythrocyte sedimentation rate (ESR) were evaluated in this study.
METHODS
A systematic computer-based search was performed for relevant articles focusing on the ESR diagnosis of pediatric osteomyelitis in PubMed, Embase, and the Cochrane Library with an inclusion criteria: 1) the diagnostic utility of ESR for diagnosing osteomyelitis patients under the age of 18;2) two-by-two contingency tables can be obtained. Case reports, review papers, and animal experiments were excluded.
RESULTS
The diagnostic meta-analysis included 8 studies involving 348 children with osteomyelitis, all of whom were tested for ESR. Diagnostic meta-analysis revealed a sensitivity and specificity of 0.90, 95% confidence interval (CI) (0.86-0.93), and 0.50 (95% CI,0.47-0.54) for ESR in pediatric osteomyelitis diagnosis, respectively. The positive likelihood ratio (LR), negative LR, and diagnostic odds ratio were 1.38,(95% CI,1.08-1.78), 0.46, (95% CI,0.26-0.73), and 3.20, (95% CI,1.33-7.69), respectively. The area under the curve (AUC) was determined to be 0.80 based on the summary receiver operating characteristic curve (SROC).
CONCLUSION
The literature on the use of ESR in pediatric osteomyelitis diagnosis was thoroughly reviewed in this study. It was also found that ESR may be useful as a biomarker for pediatric osteomyelitis diagnosis. Due to its low specificity, it should be used in combination with other markers such as C-reactive protein, neutrophil percentage, and white blood cell count.
PubMed: 38089965
DOI: 10.2147/TCRM.S440996 -
Healthcare (Basel, Switzerland) Sep 2022(1) Background: Cartilage degeneration with the natural aging process and the role of physical activity on cartilage wellness is still not clear. The objective of the... (Review)
Review
(1) Background: Cartilage degeneration with the natural aging process and the role of physical activity on cartilage wellness is still not clear. The objective of the present review was to understand how different physical activity interventions affect the cartilage and to propose a Standard Operating Procedure for an exercise program to maintain knee joint health; (2) Methods: Articles were collected on three different electronic databases and screened against the eligibility criteria. Results were collected in tables and the main outcomes were discussed narratively; (3) Results: A total of 24 studies have been included after the screening process and aerobic, strength, flexibility, postural balance, and mobility interventions were detected. Different protocols and types of interventions were adopted by the authors; (4) Conclusions: Physical activity interventions have mainly positive outcomes on cartilage structure, but the protocols adopted are different and various. A Standard Operating Procedure has been proposed for a physical intervention focalized on cartilage wellness that could be adopted as an intervention in the clinical setting. Furthermore, the creation of a standardized protocol wants to help scientific research to move in the same direction.
PubMed: 36292268
DOI: 10.3390/healthcare10101821 -
Clinical Epigenetics Nov 2022The factors affecting cardioprotective collateral circulation are still incompletely understood. Recently, characteristics, such as CpG methylation of cell-free DNA...
BACKGROUND
The factors affecting cardioprotective collateral circulation are still incompletely understood. Recently, characteristics, such as CpG methylation of cell-free DNA (cfDNA), have been reported as markers with clinical utility. The aim of this study was to evaluate whether cfDNA methylation patterns are associated with the grade of coronary collateral circulation (CCC).
RESULT
In this case-control study, clinical and angiographic data were obtained from 143 patients (mean age, 58 years, male 71%) with chronic total coronary occlusion. Enzymatic methyl-sequencing (EM-seq) libraries were prepared using the cfDNA extracted from the plasma. Data were processed to obtain the average methylation fraction (AMF) tables of genomic regions from which blacklisted regions were removed. Unsupervised analysis of the obtained AMF values showed that some of the changes in methylation were due to CCC. Through random forest preparation process, 256 differentially methylated region (DMR) candidates showing strong association with CCC were selected. A random forest classifier was then constructed, and the area under the curve of the receiver operating characteristic curve indicated an appropriate predictive function for CCC. Finally, 20 DMRs were identified to have significantly different AMF values between the good and poor CCC groups. Particularly, the good CCC group exhibited hypomethylated DMRs. Pathway analysis revealed five pathways, including TGF-beta signaling, to be associated with good CCC.
CONCLUSION
These data have demonstrated that differential hypomethylation was identified in dozens of cfDNA regions in patients with good CCC. Our results support the clinical utility of noninvasively obtained epigenetic signatures for predicting collateral circulation in patients with vascular diseases.
Topics: Humans; Male; Middle Aged; Case-Control Studies; Cell-Free Nucleic Acids; Collateral Circulation; Coronary Artery Disease; DNA Methylation; Female
PubMed: 36320085
DOI: 10.1186/s13148-022-01349-w -
Journal of Applied Clinical Medical... Aug 2022Motion management of tumors within the lung and abdomen is challenging because it requires balancing tissue sparing with accuracy of hitting the target, while...
PURPOSE
Motion management of tumors within the lung and abdomen is challenging because it requires balancing tissue sparing with accuracy of hitting the target, while considering treatment delivery efficiency. Physicists can play an important role in analyzing four-dimensional computed tomography (4DCT) data to recommend the optimal respiratory gating parameters for a patient. The goal of this work was to develop a standardized procedure for making recommendations regarding gating parameters and planning margins for lung and gastrointestinal stereotactic body radiotherapy (SBRT) treatments. In doing so, we hoped to simplify decision-making and analysis, and provide a tool for troubleshooting complex cases.
METHODS
Factors that impact gating decisions and planning target volume (PTV) margins were identified. The gating options included gating on exhale with approximately a 50% duty cycle (Gate3070), exhale gating with a reduced duty cycle (Gate4060), and treating for most of respiration, excluding only extreme inhales and exhales (Gate100). A standard operating procedure was developed, as well as a physics consult document to communicate motion management recommendations to other members of the treatment team. This procedure was implemented clinically for 1 year and results are reported below.
RESULTS
Identified factors that impact motion management included the magnitude of motion observed on 4DCT, the regularity of breathing and quality of 4DCT data, and ability to observe the target on fluoroscopy. These were collated into two decision tables-one specific to lung tumors and another for gastrointestinal tumors-such that a physicist could answer a series of questions to determine the optimal gating and PTV margin. The procedure was used clinically for 252 sites from 213 patients treated with respiratory-gated SBRT and standardized practice across our 12-member physics team.
CONCLUSION
Implementation of a standardized procedure for respiratory gating had a positive impact in our clinic, improving efficiency and ease of 4DCT analysis and standardizing gating decision-making amongst physicists.
Topics: Four-Dimensional Computed Tomography; Humans; Lung Neoplasms; Motion; Movement; Radiosurgery; Radiotherapy Planning, Computer-Assisted; Respiration; Workflow
PubMed: 35737295
DOI: 10.1002/acm2.13705 -
International Journal of Computer... Mar 2022In-depth knowledge about surgical processes is a crucial prerequisite for future systems in operating rooms and the advancement of standards and patient safety in...
OBJECTIVES
In-depth knowledge about surgical processes is a crucial prerequisite for future systems in operating rooms and the advancement of standards and patient safety in surgery. A holistic approach is required, but research in the field of surgical instrument tables, standardized instrument setups and involved personnel, such as nurses, is sparse in general. The goal of this study is to evaluate whether there is an existing standard within clinics for an instrument table setup. We also evaluate to which extent it is known to the personnel and whether it is accepted.
MATERIALS AND METHODS
The study makes use of the Nosco Trainer, a scrub nurse training and simulation system developed to analyze various aspects of the workplace of scrub nurses. The system contains a virtual instrument table, which is used to perform and record instrument table setups. We introduce a metric which delivers a measurable score for the similarity of surgical instrument table setups. The study is complemented with a questionnaire covering related aspects.
RESULTS
Fifteen scrub nurses of the Otolaryngology departments at three clinics in Germany and Switzerland performed a table setup for a Functional Endoscopic Sinus Surgery intervention and completed the questionnaire. The analysis of the developed metric with a leave one out cross-validation correctly allocated 14 of the 15 participants to their clinic.
DISCUSSION
In contrast to the identified similarities of table setups within clinics with the collected data, only a third of the participants confirmed in the questionnaire that there is an existing table setup standard for Functional Endoscopic Sinus Surgery interventions in their facility, but almost three quarters would support a written standard and acknowledge its possible benefits for trainees and new entrants in the operating room.
CONCLUSIONS
The structured analysis of the surgical instrument table using a data-driven metric for comparison is a novel approach to gain deeper knowledge about intra-operative processes. The insights can contribute to patient safety by improving the workflow between surgeon and scrub nurse and also open the way for goal-oriented standardization.
Topics: Computer Simulation; Humans; Operating Rooms; Otolaryngology; Reference Standards; Surgeons
PubMed: 35061169
DOI: 10.1007/s11548-021-02556-1 -
The Journal of Prevention of... 2022Preclinical Alzheimer's disease (AD) provides an opportunity for the study and implementation of interventions and strategies aimed at delaying, mitigating, and...
BACKGROUND
Preclinical Alzheimer's disease (AD) provides an opportunity for the study and implementation of interventions and strategies aimed at delaying, mitigating, and preventing AD. While this preclinical state is an ideal target, it is difficult to identify efficiently and cost-effectively. Recent findings have suggested that cognitive-motor dual task paradigms may provide additional inference.
OBJECTIVES
Investigate the relationship between dual task performance and amyloidosis, suggestive of preclinical Alzheimer's disease and whether dual task performance provides additional information beyond a cognitive composite, to help in the identification of amyloidosis.
DESIGN
Cross-sectional.
SETTING
Outpatient specialty brain health clinical research institution in the United States.
PARTICIPANTS
52 cognitively healthy adults.
MEASUREMENTS
The data included demographics, amyloid standardized uptake value ratio obtained via florbetapir-PET, neuropsychological testing, apolipoprotien E genotype, and dual task performance measures. Data were analyzed via hierarchal multiple linear regression or logistic regression, controlling for age, education, and apolipoprotien E genotype. Receiver operating characteristic curves were plotted, and sensitivity and specificity calculated via 2x2 contingency tables.
RESULTS
There was a moderate relationship (rs>.30) between motor and cognitive dual task effects and amyloid standardized uptake value ratio (ps<.042). A strong relationship (r=.58) was found between combined dual task effect, a measure of automaticity derived from dual task performance, and amyloid standardized uptake value ratio (p<.001). Additionally, combined dual task effect showed promise in its unique contributions to amyloid standardized uptake value ratio, accounting for 7.8% of amyloid standardized uptake value ratio variance beyond cognitive composite scores (p=.018). Additionally, when incorporated into the cognitive composite, combined dual task effect resulted in improved diagnostic accuracy for determining elevated amyloid standardized uptake value ratio, and increased the sensitivity and specificity of the cognitive composite.
CONCLUSSION
Dual task performance using the combined dual task effect, a measure of automaticity, was a moderate predictor of cerebral amyloidosis, which suggests that it has utility in the screening and diagnosis of individuals for preclinical AD. Additionally, when combined with the cognitive composite, the combined dual task effect improves diagnostic accuracy. Further research is warranted.
Topics: Adult; Alzheimer Disease; Amyloid; Amyloid beta-Peptides; Amyloidosis; Cross-Sectional Studies; Humans; Positron-Emission Tomography; Task Performance and Analysis
PubMed: 35543003
DOI: 10.14283/jpad.2022.1 -
Methods of Information in Medicine Jun 2022Receiver operating characteristic (ROC) analysis is commonly used for comparing models and humans; however, the exact analytical techniques vary and some are flawed. (Review)
Review
BACKGROUND
Receiver operating characteristic (ROC) analysis is commonly used for comparing models and humans; however, the exact analytical techniques vary and some are flawed.
OBJECTIVES
The aim of the study is to identify common flaws in ROC analysis for human versus model performance, and address them.
METHODS
We review current use and identify common errors. We also review the ROC analysis literature for more appropriate techniques.
RESULTS
We identify concerns in three techniques: (1) using mean human sensitivity and specificity; (2) assuming humans can be approximated by ROCs; and (3) matching sensitivity and specificity. We identify a technique from Provost et al using dominance tables and cost-prevalence gradients that can be adapted to address these concerns.
CONCLUSION
Dominance tables and cost-prevalence gradients provide far greater detail when comparing performances of models and humans, and address common failings in other approaches. This should be the standard method for such analyses moving forward.
Topics: Humans; Prevalence; ROC Curve; Research Design; Sensitivity and Specificity
PubMed: 34972233
DOI: 10.1055/s-0041-1740565 -
Advanced Biomedical Research 2023Ocular trauma is one of the most common causes of hospitalization in patients with ocular injuries. It imposes many direct and indirect physical and psychological costs...
BACKGROUND
Ocular trauma is one of the most common causes of hospitalization in patients with ocular injuries. It imposes many direct and indirect physical and psychological costs on the patient and the community.
MATERIALS AND METHODS
The present descriptive cross-sectional and retrospective study includes all patients with ocular trauma who underwent surgery in the referral center's ophthalmic operating room for 10 years. A checklist was completed for each patient, including demographic information and the variables required for the study. A total of 927 patients who underwent eye surgery due to ocular trauma were eligible for the study. All descriptive data were reported as the mean plus standard deviation for quantitative variables and distribution tables and frequency percentage for qualitative variables. Inferential tests such as independent t-test and Chi-square test were used to evaluate the research questions.
RESULTS
This study showed that most ocular traumas occur at a young age and mostly in males. The types of trauma in the studied eyes were divided into penetrating and non-penetrating in different age groups. The results showed that the most common type of surgery was corneal laceration repair, and in all patients, visual acuity improved significantly after surgery. In this study, a total of 81% of patients underwent only one operation.
CONCLUSIONS
Training and caring for children and adolescents about high-risk behaviors and educating industry professionals to wear goggles, and increase workplace safety can reduce these types of trauma.
PubMed: 37200739
DOI: 10.4103/abr.abr_108_21 -
Journal of the American Heart... Dec 2023The Diamond-Forrester model was used extensively to predict obstructive coronary artery disease (CAD) but overestimates probability in current populations. Coronary...
BACKGROUND
The Diamond-Forrester model was used extensively to predict obstructive coronary artery disease (CAD) but overestimates probability in current populations. Coronary artery calcium (CAC) is a useful marker of CAD, which is not routinely integrated with other features. We derived simple likelihood tables, integrating CAC with age, sex, and cardiac chest pain to predict obstructive CAD.
METHODS AND RESULTS
The training population included patients from 3 multinational sites (n=2055), with 2 sites for external testing (n=3321). We determined associations between age, sex, cardiac chest pain, and CAC with the presence of obstructive CAD, defined as any stenosis ≥50% on coronary computed tomography angiography. Prediction performance was assessed using area under the receiver-operating characteristic curves (AUCs) and compared with the CAD Consortium models with and without CAC, which require detailed calculations, and the updated Diamond-Forrester model. In external testing, the proposed likelihood tables had higher AUC (0.875 [95% CI, 0.862-0.889]) than the CAD Consortium clinical+CAC score (AUC, 0.868 [95% CI, 0.855-0.881]; =0.030) and the updated Diamond-Forrester model (AUC, 0.679 [95% CI, 0.658-0.699]; <0.001). The calibration for the likelihood tables was better than the CAD Consortium model (Brier score, 0.116 versus 0.121; =0.005).
CONCLUSIONS
We have developed and externally validated simple likelihood tables to integrate CAC with age, sex, and cardiac chest pain, demonstrating improved prediction performance compared with other risk models. Our tool affords physicians with the opportunity to rapidly and easily integrate a small number of important features to estimate a patient's likelihood of obstructive CAD as an aid to clinical management.
Topics: Humans; Coronary Artery Disease; Calcium; Coronary Angiography; Risk Assessment; Calcium, Dietary; Chest Pain; Predictive Value of Tests; Risk Factors
PubMed: 38108259
DOI: 10.1161/JAHA.123.031601