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SensitivityAndSpecificity

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Emergency Medicine Literature of Note: The Case of the Bloody Lumbar Punctures

Would welcome your thoughts on this article - Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ 2011; 343. Perry JJ, et al.many thanks, Chris  
emlitofnote.com
almost 5 years ago
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23

Blind Swab vs Speculum-assisted Endocervical Swab - HQMedEd.com

What is the evidence regarding the relative sensitivity and specificity of provider-administered blind swab when compared to that taken from the endocervix during speculum exam?  
hqmeded.com
almost 5 years ago
Static.www.bmj
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How to read a receiver operating characteristic curve

Researchers investigated the use of vital signs as a screening test to identify brain lesions in patients with impaired consciousness. The setting was an emergency department in Japan. In total, 529 consecutive patients presenting with impaired consciousness, as assessed by a score of less than 15 on the Glasgow coma scale, were studied. Patients were followed until discharge. The vital signs of systolic and diastolic blood pressure plus pulse rate were recorded on arrival. The diagnosis of a brain lesion was determined on the basis of brain imaging and neurological examination. In total, 312 patients (59%) were diagnosed with a brain lesion.1  
feeds.bmj.com
over 4 years ago
Www.bmj
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Assessment of chest pain in a low risk patient: is the exercise tolerance test obsolete?

The coronary artery calcium score has high sensitivity for detecting coronary stenosis—so a negative result makes significant coronary stenosis unlikely—but low specificity, and 60% of those without coronary artery disease will also have a positive result  
feeds.bmj.com
over 4 years ago
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Assessment of chest pain in a low risk patient: is the exercise tolerance test obsolete?

The coronary artery calcium score has high sensitivity for detecting coronary stenosis—so a negative result makes significant coronary stenosis unlikely—but low specificity, and 60% of those without coronary artery disease will also have a positive result  
feeds.bmj.com
over 4 years ago
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146

Antifungal Sensitivity Testing

Anti fungal Sensitivity Testing  
slideshare.net
over 4 years ago
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15

Intravenous infusion of lidocaine starting at the time of surgery for reduction of pain and improvement of recovery after surgery | Cochrane

The most common problems immediately following surgery are pain, nausea and vomiting, excessive blood clotting, slowing or stopping of the movement of food and fluid through the digestive system, and postoperative cognitive dysfunction. Fast-track protocols aim to prevent or reduce these complications and speed up early recovery. Opioid medications that are given to reduce the postoperative pain can be associated with side effects including nausea and constipation, which prevent a smooth recovery. Other options include the administration of epidural opioid medications (injected into the space surrounding the spinal cord). The pain can be a mixture of inflammatory and neuropathic pain or based on increased sensitivity to pain. All are helped by intravenous lidocaine, which is a non-opioid local pain medication or local anaesthetic.  
cochrane.org
over 4 years ago
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Emergency Medicine Literature of Note: The No-CT in Trauma Experience

Yes – sensitivity and specificity limitations (+LR/-LR) can be rendered moot by pretest likelihood, to put it mildly ....  
emlitofnote.com
over 4 years ago
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15

Critical Care

Metrics typically used to report the performance of an early warning score (EWS), such as the area under the receiver operator characteristic curve or C-statistic, are not useful for pre-implementation analyses. Because physiological deterioration has an extremely low prevalence of 0.02 per patient-day, these metrics can be misleading. We discuss the statistical reasoning behind this statement and present a novel alternative metric more adequate to operationalize an EWS. We suggest that pre-implementation evaluation of EWSs should include at least two metrics: sensitivity; and either the positive predictive value, number needed to evaluate, or estimated rate of alerts. We also argue the importance of reporting each individual cutoff value.  
ccforum.com
over 4 years ago
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Emergency Medicine Literature of Note: The Battle for Age-Adjusted D-Dimer

edited for mispellings I need to have a look at the full paper when I can get hold of it , but age adjusted D Dimer has been validated ONLY for some HIGH SENSITIVITY D DIMER kits. Well, methinks.Besides, how do we know the EPs are not overdiagnoses ?  
emlitofnote.com
over 4 years ago
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29

Differences in Mechanosensory Discrimination Across the Body Surface - Neuroscience - NCBI Bookshelf

The accuracy with which tactile stimuli can be sensed varies from one region of the body to another, a phenomenon that illustrates some further principles of somatic sensation. Figure 9.4 shows the results of an experiment in which variation in tactile ability across the body surface was measured by two-point discrimination. This technique measures the minimal interstimulus distance required to perceive two simultaneously applied stimuli as distinct (the indentations of the points of a pair of calipers, for example). When applied to the skin, such stimuli of the fingertips are discretely perceived if they are only 2 mm apart. In contrast, the same stimuli applied to the forearm are not perceived as distinct until they are at least 40 mm apart! This marked regional difference in tactile ability is explained by the fact that the encapsulated mechanoreceptors that respond to the stimuli are three to four times more numerous in the fingertips than in other areas of the hand, and many times more dense than in the forearm. Equally important in this regional difference are the sizes of the neuronal receptive fields. The receptive field of a somatic sensory neuron is the region of the skin within which a tactile stimulus evokes a sensory response in the cell or its axon (Boxes A and B). Analysis of the human hand shows that the receptive fields of mechanosensory neurons are 1–2 mm in diameter on the fingertips but 5–10 mm on the palms. The receptive fields on the arm are larger still. The importance of receptive field size is easy to envision. If, for instance, the receptive fields of all cutaneous receptor neurons covered the entire digital pad, it would be impossible to discriminate two spatially separate stimuli applied to the fingertip (since all the receptive fields would be returning the same spatial information). Figure 9.4Variation in the sensitivity of tactile discrimination as a function of location on the body surface, measured here by two-point discrimination. (After Weinstein, 1969.)  
ncbi.nlm.nih.gov
over 4 years ago
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Treating Transgender Patients: A Primer

Dr Ranit Mishori discusses transgender patient sensitivity, diagnosis, and treatment, encouraging doctors to ask about more than just hormone use.  
medscape.com
over 4 years ago
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High-Sensitivity Troponin for Rapid MI Rule-In/Rule-Out

Dr Westermann provides topline findings from the Biomarkers in Acute Cardiovascular Care study from ESC.  
medscape.com
over 4 years ago
Sinaiem dark
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pocus-ruq

One recently published prospective cross-sectional study (Villar et al., 2015) suggested simplifying the definition of a positive POCUS test to be presence of gallstones alone. With the simplified definition in evaluating for acute cholecystitis, POCUS had a sensitivity of 100% and NPV 100%. In other words, absence of gallstones alone rules out acute cholecystitis. [1]  
sinaiem.org
over 4 years ago
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Authors’ reply to Gupta

In answer to Gupta,1 we performed additional sensitivity analyses to investigate the influence of ethnicity on the variation in 30 day mortality after acute myocardial infarction (AMI) in UK hospitals.2  
feeds.bmj.com
over 4 years ago
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26

Celiac disease and non-celiac gluten sensitivity

Celiac disease is a multisystem immune based disorder that is triggered by the ingestion of gluten in genetically susceptible individuals. The prevalence of celiac disease has risen in recent decades and is currently about 1% in most Western populations. The reason for this rise is unknown, although environmental factors related to the hygiene hypothesis are suspected. The pathophysiology of celiac disease involves both the innate and adaptive immune response to dietary gluten. Clinical features are diverse and include gastrointestinal symptoms, metabolic bone disease, infertility, and many other manifestations. Although a gluten-free diet is effective in most patients, this diet can be burdensome and can limit quality of life; consequently, non-dietary therapies are at various stages of development. This review also covers non-celiac gluten sensitivity. The pathophysiology of this clinical phenotype is poorly understood, but it is a cause of increasing interest in gluten-free diets in the general population.  
feeds.bmj.com
over 4 years ago
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Celiac disease and non-celiac gluten sensitivity

Celiac disease is a multisystem immune based disorder that is triggered by the ingestion of gluten in genetically susceptible individuals. The prevalence of celiac disease has risen in recent decades and is currently about 1% in most Western populations. The reason for this rise is unknown, although environmental factors related to the hygiene hypothesis are suspected. The pathophysiology of celiac disease involves both the innate and adaptive immune response to dietary gluten. Clinical features are diverse and include gastrointestinal symptoms, metabolic bone disease, infertility, and many other manifestations. Although a gluten-free diet is effective in most patients, this diet can be burdensome and can limit quality of life; consequently, non-dietary therapies are at various stages of development. This review also covers non-celiac gluten sensitivity. The pathophysiology of this clinical phenotype is poorly understood, but it is a cause of increasing interest in gluten-free diets in the general population.  
feeds.bmj.com
over 4 years ago
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Biomarkers Update: High-Sensitivity Troponin and BNP

Drs Piña and Januzzi review data from ESC on high-sensitivity troponin and how to monitor BNP in patients on Entresto™.  
medscape.com
over 4 years ago
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Gluten Sensitivity in Those Without Celiac Disease

What does the latest research tell us about the different degrees of gluten sensitivity in patients diagnosed with non-celiac gluten sensitivity?  
medscape.com
over 4 years ago
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Critical Care

A continued need exists for effective diagnostic biomarkers in bacterial sepsis among critically ill patients, despite increasing use of available biomarkers such as procalcitonin (PCT). Interleukin-27 (IL-27) has shown early promise in a recent preliminary study, exhibiting high specificity and positive predictive values for bacterial infection in critically ill children. This validation study was performed to assess the value of IL-27 in predicting bacterial infection among patients admitted to the pediatric intensive care unit and to compare its performance with that of PCT.  
ccforum.com
about 4 years ago