Validation of three health literacy screening questions compared with S-TOFHLA in a low-income diverse English- and Spanish-Speaking population.

BACKGROUND: Clinicians need a tool to gauge patients' ability to understand health conditions and treatment options. The Short-form Test of Functional Health Literacy in Adults (S-TOFHLA) is the gold standard for this, but its length is prohibitive for use in clinical settings. This study seeks to validate a novel three-item question set for predicting health literacy. METHODS: This cross-sectional study utilized an in-person questionnaire alongside the S-TOFHLA. The sample included 2027 English- and Spanish-speaking adults (≥18 years) recruited from primary care practices serving a low-income eastern Pennsylvania community. Most patients (57.7%) identified as Hispanic. Diagnostic accuracy of each question and aggregated scores were assessed against the validated survey by calculating the area under the receiver operating characteristic (AUROC) curve. RESULTS: Questions in the 'Problems Learning' and 'Help Reading' domains (AUROC 0.66 for each) performed better than the 'Confident Forms' question (AUROC 0.64). Summing all three scores resulted in an even higher AUROC curve (0.71). Cronbach's alpha of the combined items was 0.696. CONCLUSIONS: Study results suggest that any of the three questions are viable options for screening health literacy levels of diverse patients in primary care clinical settings. However, they perform better as a summed score than when used individually.

Thyroid-Stimulating Antibody/Thyroid-Stimulating Hormone Receptor Antibody Ratio as a Sensitive Screening Test for Active Graves' Orbitopathy.

OBJECTIVE: Graves' orbitopathy (GO), an extrathyroidal manifestation of Graves' disease, can seriously threaten a patient's quality of life. Given that immunosuppressive treatment during the early active phase of GO has been found to reduce both disease activity and severity, sensitive screening tests are needed. METHODS: The present study included 86 patients with GO, in whom serum levels of thyroid-stimulating hormone (TSH), free triiodothyronine (T3), free thyroxine, thyroid-stimulating antibody, TSH receptor antibody, thyroid peroxidase antibody, thyroglobulin, and thyroglobulin antibody were measured within 2 months before magnetic resonance imaging (MRI) for orbit assessment. RESULTS: The thyroid-stimulating antibody/TSH receptor antibody ratio was able to distinguish MRI results with a correct classification rate of 81%. When focusing on patients without T3 predominant Graves' diseases, the ratio distinguished MRI results at a rate of 92%. Receiver operating characteristic curve analysis revealed a cutoff antibody ratio of 87, which yielded a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 91%, 95%, 18.2, and 0.0957, respectively, for distinguished MRI results. CONCLUSIONS: The thyroid-stimulating antibody/TSH receptor antibody ratio is a highly sensitive and specific indicator for active GO, especially in patients without T3 predominance, and serves as a good screening test for active GO in primary care settings.

Identifying older adults with frailty approaching end-of-life: A systematic review.

BACKGROUND: People with frailty may have specific needs for end-of-life care, but there is no consensus on how to identify these people in a timely way, or whether they will benefit from intervention. AIM: To synthesise evidence on identification of older people with frailty approaching end-of-life, and whether associated intervention improves outcomes. DESIGN: Systematic review (PROSPERO: CRD42020462624). DATA SOURCES: Six databases were searched, with no date restrictions, for articles reporting prognostic or intervention studies. Key inclusion criteria were adults aged 65 and over, identified as frail via an established measure. End-of-life was defined as the final 12 months. Key exclusion criteria were proxy definitions of frailty, or studies involving people with cancer, even if also frail. RESULTS: Three articles met the inclusion criteria. Strongest evidence came from one study in English primary care, which showed distinct trajectories in electronic Frailty Index scores in the last 12 months of life, associated with increased risk of death. We found no studies evaluating established clinical tools (e.g. Gold Standards Framework) with existing frail populations. We found no intervention studies; the literature on advance care planning with people with frailty has relied on proxy definitions of frailty. CONCLUSION: Clear implications for policy and practice are hindered by the lack of studies using an established approach to assessing frailty. Future end-of-life research needs to use explicit approaches to the measurement and reporting of frailty, and address the evidence gap on interventions. A focus on models of care that incorporate a palliative approach is essential.

Validating a Pragmatic Approach to Cognitive Screening in Stroke Prevention Clinics Using the Montreal Cognitive Assessment.

BACKGROUND AND PURPOSE: The Montreal Cognitive Assessment (MoCA) is used commonly to identify cognitive impairment (CI), but there are multiple published cut points for normal and abnormal. We seek to validate a pragmatic approach to screening for moderate-severe CI, by classifying patients into high-, intermediate-, and low-risk categories. METHODS: A total of 390 participants attending an academic Stroke Prevention Clinic completed the MoCA and more detailed neuropsychological testing. Between April 23, 2012 and April 30, 2014, all consecutive new referrals to the regional Stroke Prevention Clinic who were English-speaking, not severely aphasic, and could see and write well enough to complete neuropsychological testing were assessed for inclusion, and consenting patients were enrolled. CI was defined as ≥2 SDs below normal for age and education on at least 2 cognitive subtests. A single cut point for CI was compared with 2 cut points (high sensitivity and high specificity) generated using receiver operator characteristic and area under the curve analyses. The intermediate-risk group contained those scoring between the 2 cut points. RESULTS: Thirty-four percent of participants had a symptomatic or silent stroke, 34% were seen for possible or probable transient ischemic attack, and 32% were diagnosed with other vascular or nonvascular conditions. Using a single cut point, sensitivity and specificity were optimal with MoCA ≤22, (sensitivity=60.4%, specificity=89.9%, area under the curve=0.801, positive predictive value=48.5%, negative predictive value=93.5%, positive likelihood ratio=6, and negative likelihood ratio=0.4). Using 2 cut points, sensitivity was optimal with MoCA ≥28 (sensitivity=96.2%, negative predictive value =97.6%, and negative likelihood ratio=1.27), and specificity was optimal with MoCA ≤22 (specificity=89.9%, positive predictive value=48.5%, and positive likelihood ratio=6). CONCLUSIONS: Stratifying participants into 3 categories facilitates the identification of a homogenous group at low risk for CI, as well as 2 other groups with intermediate and higher risk. This approach could facilitate clinical care pathways and patient selection for research.

Time-Resolved C-Arm Computed Tomographic Angiography Derived From Computed Tomographic Perfusion Acquisition: New Capability for One-Stop-Shop Acute Ischemic Stroke Treatment in the Angiosuite.

BACKGROUND AND PURPOSE: Multimodal imaging using cone beam C-arm computed tomography (CT) may shorten the delay from ictus to revascularization for acute ischemic stroke patients with a large vessel occlusion. Largely because of limited temporal resolution, reconstruction of time-resolved CT angiography (CTA) from these systems has not yielded satisfactory results. We evaluated the image quality and diagnostic value of time-resolved C-arm CTA reconstructed using novel image processing algorithms. METHODS: Studies were done under an Institutional Review Board approved protocol. Postprocessing of data from 21 C-arm CT dynamic perfusion acquisitions from 17 patients with acute ischemic stroke were done to derive time-resolved C-arm CTA images. Two observers independently evaluated image quality and diagnostic content for each case. ICC and receiver-operating characteristic analysis were performed to evaluate interobserver agreement and diagnostic value of this novel imaging modality. RESULTS: Time-resolved C-arm CTA images were successfully generated from 20 data sets (95.2%, 20/21). Two observers agreed well that the image quality for large cerebral arteries was good but was more limited for small cerebral arteries (distal to M1, A1, and P1). receiver-operating characteristic curves demonstrated excellent diagnostic value for detecting large vessel occlusions (area under the curve=0.987-1). CONCLUSIONS: Time-resolved CTAs derived from C-arm CT perfusion acquisitions provide high quality images that allowed accurate diagnosis of large vessel occlusions. Although image quality of smaller arteries in this study was not optimal ongoing modifications of the postprocessing algorithm will likely remove this limitation. Adding time-resolved C-arm CTAs to the capabilities of the angiography suite further enhances its suitability as a one-stop shop for care for patients with acute ischemic stroke.

The Asthma Control Test, Japanese Version (ACT-J) as a Predictor of Global Initiative for Asthma (GINA) Guideline-Defined Asthma Control: Analysis of a Questionnaire-Based Survey.

BACKGROUND: The 2006 Global Initiative for Asthma (GINA 2006) guidelines emphasize the importance of evaluating the control rather than the severity of asthma. The Asthma Control Test (ACT) is well known to be an excellent tool for evaluating asthma control in the clinical setting. This study aimed to evaluate the ACT, Japanese version (ACT-J) as a predictor of asthma control as defined by the GINA 2006 guidelines in actual clinical practice. METHODS: A cross-sectional analysis comparing the ACT-J score and GINA classification of asthma control among 419 patients of primary care physicians and specialists was performed using the data from a 2010 questionnaire-based survey conducted by the Niigata Asthma Treatment Study Group. RESULTS: The optimal cut-off point of the ACT-J score for predicting GINA-defined asthma control was 23, with ACT-J scores of ≥23 and ≤22 predicting controlled and uncontrolled asthma with area under the receiver operating characteristics curve values of 0.76 [95% confidence interval (CI): 0.72-0.81] and 0.93 [95% CI: 0.900.97], respectively. CONCLUSIONS: ACT scores of ≥23 and ≤22 are useful for identifying patients with controlled and uncontrolled asthma, respectively, as defined by GINA 2006, and the latter is more strongly predictive than the former. The reason for the higher cut-off point of the ACT-J relative to other versions of the ACT is unclear and warrants further investigation.

Clinically important estimates of improvement after septoplasty.

OBJECTIVE: A statistically significant improvement in nasal obstruction ratings following septoplasty is not necessarily clinically important. This study aimed to establish useful measures of septoplasty success, namely the minimal clinically important difference and the desirable clinically important difference. METHODS: Patients rated nasal obstruction on a 0-100 visual analogue scale pre-operatively and at 5.5 months post-operatively. Global outcome rating (completely, much, or somewhat improved, unchanged or worse) served as the anchor post-operatively. Minimal clinically important difference is the visual analogue scale value between 'somewhat improved' and 'unchanged', and the desirable clinically important difference is that between 'much' and 'somewhat improved'. RESULTS: Statistically significant improvement in visual analogue scale scores was not clinically important. The minimal clinically important difference (daytime value of 9.5) represented 15.1 per cent improvement and the desirable clinically important difference (daytime value of 28.5) represented 45.2 per cent, without gender or age differences. CONCLUSION: Clinical success can be defined using a minimal clinically important difference of 15 per cent improvement over a patient's baseline value. Other studies' ratings of 'satisfactory' outcome coincided with a desirable clinically important difference of 45 per cent over baseline. These values are suggested as relevant indicators of septoplasty success.

Optimal BMI cutoff points in obesity screening for Chinese college students.

Objective: An accurate BMI classification system specific to the population is of great value in health promotion. Existing studies have shown that the BMI recommended cut-off value for adults is not suitable for college students. Thus, the current study aims to identify optimal BMI cutoff points in obesity screening for Chinese college students. Methods: Anthropometric assessments were performed on 6,798 college students (Male = 3,408, Female = 3,390) from three universities in Jiangsu, China. Exploratory factor analysis (EFA) was conducted to establish the standardized models to estimate anthropometry for male and female students. Further indices were derived from the assessments, including body mass index (BMI), relative fat mass (RFM), obesity degree percentage (OBD%), waist-to-hip ratio (WHR), waist circumference (WC), and body fat percentage (BF%). The anthropometric index with the highest correlation to the models for male and female students were selected as the gold standard for obesity screening. Receiver operating characteristic (ROC) curve was applied to evaluate diagnostic value of each anthropometric index according to the area under curve (AUC). Youden index maximum points determined the optimal cutoff points with the highest accuracy in obesity screening. Results: The anthropometric models for both male and female students consisted of three factors. Vervaeck index was selected as the gold standard for obesity screening. By comparing AUC of the anthropometric indices, we found BMI provided the highest value in obesity screening. Further analysis based on Youden index identified the optimal BMI of 23.53 kg/m2 for male and 23.41 kg/m2 for female. Compared with the universal standard recommended by World Health Organization (WHO), the adjusted BMI criteria were characterized by high sensitivity as well as specificity. Conclusion: BMI is the most appropriate anthropometric index of obesity screening for Chinese college students. The optimal cutoff points were lower than the WHO reference. Evidence substantiated the adjusted BMI criteria as an effective approach to improve accuracy of obesity screening for this population.

Transforaminal Epidural Steroid Injection for Zoster-Related Pain: The Golden Period for the Best Outcome.

BACKGROUND: Zoster-related pain (ZRP) has many negative effects on a patient's quality of life. The transforaminal steroid injection (TFESI), which reduces neural inflammation and pain, has been advocated by pain physicians. Many reports demonstrated that early administration of TFESI showed better efficacy; however, the golden period during which TFESI is most effective remains unclear. OBJECTIVES: This multicentre retrospective cohort study aimed to identify the golden period by which TFESI yields the best outcome in patients with ZRP. STUDY DESIGN: Multicenter, retrospective cohort study. SETTING: University-affiliated hospitals. METHODS: After performing the TFESI in patients with ZRP, the patients were classified into two groups: the effective group (E) and the not effective group (N) based on the changes in the pain intensity 3 months after the TFESI. The receiver operating characteristic (ROC) curve analysis was used to assess the cut-off time point for predicting TFESI effectiveness. Furthermore, a logistic regression analysis was performed to identify patients' factors associated with a successful treatment outcome. RESULT: Of the 302 patients, 186 and 116 patients were classified into the E and N group, respectively. ROC curve analysis showed that the best cut-off time point for TFESI was 12 weeks (95% confidence interval [CI]; 10-14 weeks) after the onset of HZ. The only variable associated with a favorable outcome was a symptom duration of ? 12 weeks compared with > 12 weeks (Odd ratio, 0.107; 95% CI, 0.055-0.205; P < 0.001). Other patient variables were not significantly associated with the effectiveness of TFESI. TFESI was most effective when administered within 12 weeks of the onset of herpes zoster. LIMITATION: This study was not a prospective randomized controlled trial (RCT) and the follow-up period was only 3 months after TFESI. CONCLUSION: TFESI is more effective when administered within 12 weeks of onset of herpes zoster.

Perceived dental care need and actual oral health status in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

OBJECTIVES: To evaluate the performance of subjective self-assessment of dental care need with objective oral disease status in a sample of Hispanics/Latinos. METHODS: Data from 13,561 participants of the 2008-2011 Hispanic Community Health Study/Study of Latinos were analyzed using complex survey procedure in SAS 9.4. Subjective self-reports of types of dental care needed (check-up or cleaning, teeth filled, teeth pulled, gum treatment, denture repair) were validated against objectively determined oral disease status [dental decay, periodontitis, bleeding on probing (BOP) and count of missing teeth]. RESULTS: Individuals who reported needing a cleaning/checkup were twice as likely to present with BOP upon oral examination (POR = 2.01, 95% CI: 1.54, 2.63). Similarly, individuals who reported needing gum treatment were more likely to present with periodontitis (POR = 1.96, 95% CI: 1.71, 2.24) and BOP (POR = 2.70, 95% CI: 2.37, 3.07) upon oral examination. In multivariable prediction modeling, demographic factors and subjective dental care measures were associated with the respective oral disease states. Moreover, the sensitivity, specificity, and area under the ROC curve for the count of missing teeth were, respectively, 77 percent, 57 percent, and 0.84, while the positive predictive value (PPV) was 26 percent. CONCLUSIONS: In bivariate analysis, self-reported type of dental care needed appear indicative of actual oral disease state and may be of value for the surveillance of oral diseases when clinical measures are unattainable. In multivariable prediction modeling, these subjective measures had low PPVs thus limiting the generalizability of our findings. Nonetheless, validation and refinement of these constructs in other populations is warranted.

Timed Up and Go na avaliação da fragilidade de pessoas idosas agricultoras do Rio Grande do Sul: estudo transversal / Timed Up and Go in assessing the frailty of older farmers in Rio Grande do Sul: cross-sectional study

Resumo Objetivos Avaliar a sensibilidade do teste Timed Up and Go test (TUG) como preditor da síndrome da fragilidade do idoso (SFI) da população rural idosa do Rio Grande do Sul (RS) e identificar a prevalência de SFI nessa população. Método Estudo transversal, realizado com 604 agricultores com mais de 60 anos de idade (321 homens e 283 mulheres) identificados por meio de conglomerados estruturados a partir das regionais da Federação dos Trabalhadores da Agricultura do Rio Grande do Sul (FETAG-RS) e respectivos sindicatos. Além de variáveis demográficas (sexo, idade), foi avaliada a mobilidade funcional mediante a realização do TUG e a fragilidade referida. A curva Receiver-Operating Characteristic (ROC) foi construída para avaliar um ponto de corte do teste TUG para fragilidade. Resultados A SFI ou fragilidade foi identificada em 52,5% (n=317) da população pesquisada; 35,1% (n=212) pré-frageis e 12,4% (n=75) não-frágeis. E o tempo médio de realização do TUG em relação ao sexo foi de 11,6 segundos para mulheres e 10,8 segundos para homens (p=0,0001). A progressão da idade esteve relacionada com maior tempo de realização do teste (idosos jovens - 60-64 anos; idosos mais velhos -75-79 e longevos - 80+ - p=0,0001). A curva ROC indicou 10 segundos na execução do teste TUG como melhor ponto de corte para diagnóstico da SF em idosos rurais. Conclusão A frequência de fragilidade e pré-fragilidade nesta pesquisa, indicam uma condição de vulnerabilidade do trabalhador rural do RS no seu processo de envelhecimento. Demonstrando, a partir do teste TUG, características de mobilidade funcional e risco de fragilidade dos agricultores mais velhos, importantes para considerações futuras sobre as singularidades da saúde dessa população e intervenções profissionais necessárias.

Abstract Objectives To evaluate the sensitivity of the Timed Up and Go test (TUG) as a predictor of frailty syndrome in the elderly (IFS) in the elderly rural population of Rio Grande do Sul (RS) and to identify the prevalence of IFS in this population. Method Cross-sectional study, carried out with 604 farmers over 60 years of age (321 men and 283 women) identified through clusters structured from the regions of the Federation of Agricultural Workers of Rio Grande do Sul (FETAG-RS) and respective unions. In addition to demographic variables (gender, age), functional mobility was assessed by performing the TUG and reported frailty. The Receiver-Operating Characteristic (ROC) curve was constructed to assess a TUG test cutoff point for frailty. Results IFS or frailty was identified in 52.5% (n=317) of the surveyed population; 35.1% (n=212) pre-frail and 12.4% (n=75) non-frail. And the mean time to perform the TUG varied according to gender was 11.6 seconds for women and 10.8 seconds for men - (p=0.0001). The progression of age was related to longer time spent on the age test (young elderly - 60-64 years old; older elderly -75-79 and oldest old - 80+ - p=0.0001). The ROC curve indicated 10 seconds in the execution of the TUG test as the best cutoff point for diagnosing the SF frailty syndrome in rural elderly. Conclusion The frequency of frailty and pre-frailty in this research indicates a condition of vulnerability of rural workers in RS in their aging process. Demonstrating, from the TUG test, characteristics of functional mobility and risk of frailty of older farmers, important for future considerations on the singularities of the health of this population and necessary professional interventions.

Índices de gravidade em vítimas de trauma contuso na terapia intensiva: capacidade preditiva de mortalidade / Índices de gravedad en las víctimas de traumas contusos en los cuidados intensivos: capacidad predictiva de la mortalidad / Severity indexes of blunt trauma victims in intensive therapy: prediction capacity for mortality

RESUMO Objetivo: Identificar a capacidade preditiva de mortalidade dos índices Revised Trauma Score, Rapid Emergency Medicine Score, modified Rapid Emergency Medicine Score e Simplified Acute Physiology Score III em vítimas de trauma contuso internadas em unidade de terapia intensiva e comparar seu desempenho. Método: Coorte retrospectiva de pacientes com trauma contuso de uma unidade de terapia intensiva a partir do registro em prontuários. Receiver Operating Characteristic e intervalo de confiança de 95% da área sob a curva foram analisados para comparar os resultados. Resultados: Dos 165 pacientes analisados, 66,7% tiveram tratamento cirúrgico. A mortalidade na unidade de terapia intensiva e no hospital foi de 17,6% e 20,6%, respectivamente. Para mortalidade na terapia intensiva, houve variação das áreas sob a curva entre 0,672 e 0,738; porém, melhores resultados foram observados em pacientes cirúrgicos (0,747 a 0,811). Resultados similares foram observados para mortalidade hospitalar. Em todas as análises, as áreas sob a curva dos índices não diferiram significativamente. Conclusão: Houve acurácia moderada dos índices de gravidade, com melhora na performance quando aplicados em pacientes cirúrgicos. Os quatro índices apresentaram predição similar para os desfechos analisados.

RESUMEN Objetivo: Identificar la capacidad predictiva de la mortalidad de los índices Revised Trauma Score, Rapid Emergency Medicine Score, modified Rapid Emergency Medicine Score y Simplified Acute Physiology Score III en víctimas de traumas contusos hospitalizadas en una unidad de cuidados intensivos y comparar su rendimiento. Método: Cohorte retrospectiva de pacientes con trauma contuso en una unidad de cuidados intensivos a partir de los registros médicos. Se analizaron el Receiver Operating Characteristic y el intervalo de confianza del 95% del área bajo la curva para comparar los resultados. Resultados: De los 165 pacientes analizados, el 66,7% recibió tratamiento quirúrgico. La mortalidad en la unidad de cuidados intensivos y en el hospital fue del 17,6% y del 20,6%, respectivamente. Para la mortalidad en la unidad de cuidados intensivos, las áreas bajo la curva oscilaron entre 0,672 y 0,738; sin embargo, se observaron mejores resultados en los pacientes quirúrgicos (0,747 a 0,811). Se observaron resultados similares para la mortalidad hospitalaria. En todos los análisis, las áreas bajo la curva de los índices no difieren significativamente. Conclusión: La precisión de los índices de gravedad fue moderada, con un mejor rendimiento cuando se aplicaron a pacientes quirúrgicos. Los cuatro índices mostraron una predicción similar para los resultados analizados.

ABSTRACT Objective: To identify the predictive capacity for mortality of the indexes Revised Trauma Score, Rapid Emergency Medicine Score, modified Rapid Emergency Medicine Score, and Simplified Acute Physiology Score III in blunt trauma victims hospitalized in an intensive care unit and compare their performance. Method: Retrospective cohort of patients with blunt trauma in an intensive care unit from medical records. Receiver Operating Characteristic and a 95% confidence interval of the area under the curve were analyzed to compare results. Results: Out of 165 analyzed patients, 66.7% have received surgical treatment. The mortality in the intensive care unit and in the hospital was 17.6% and 20.6%, respectively. For the mortality in the intensive care unit, the area under the curve varied from 0.672 to 0.738; however, better results have been observed in surgical patients (0.747 to 0.811). Similar results have been observed for in-hospital mortality. In all analyses, the areas under the curve of the indexes presented no significant difference. Conclusion: The accuracy of the severity indexes was moderate, with an improved performance when applied to surgical patients. The four indexes presented a similar prediction for the analyzed outcomes.

Predictive factors of mortality in acute aortic dissection and validity of the euroscore algorithm in a small-sized cardiac surgery institution

Abstract Introduction: Acute aortic dissection (AAD) is a devastating surgical emergency, with high operative mortality. Several scoring algorithms have been used to establish the expected mortality in these patients. Our objective was to define the predictive factors for mortality in our center and to validate the EuroSCORE and Penn classification system. Methods: Patients who underwent surgery for AAD from 2006 to 2016 were retrieved from the institution's database. Preoperative, operative and postoperative variables were collected. Observed and expected mortality was calculated by EuroSCORE. Logistic regression analysis and Cox regression analysis were performed to find predictors of operative mortality and survival, respectively. The receiver operating characteristic (ROC) curves were plotted for logistic EuroSCORE, and the area under the ROC curve (AUC) was calculated. Results: 87 patients (27.6% female) underwent surgery for AAD. The mean age was 58.6±9.7 years. Expected and observed operative mortality was 25.8±15.1% and 20.7%, respectively. Penn Aa, Ab and Abc shared similar observed/expected (O/E) mortality ratio. The only independent predictor of operative mortality (OR: 3.63; 95% CI: 1.19-11.09) and survival (HR: 2.6; 95% CI: 1.5-4.8) was female gender. EuroSCORE showed a very poor prediction capacity, with an AUC=0.566. Conclusion: Female gender was the only independent predictor of operative mortality and survival in our institution. EuroSCORE is a poor scoring algorithm to predict mortality in AAD, but with consistent results for Penn Aa, Ab and Abc.

Sensitivity and specificity of assessment scales of dentin hypersensitivity - an accuracy study

Abstract The aim of the present study was to compare the sensitivity and specificity of pain scales used to assess dentin hypersensitivity (DH). The preferred scale, and toothbrushing habits of participants were also investigated. This cross-sectional study was conducted with students and employees of a Brazilian Federal University who presented DH. The participants answered a questionnaire about their toothbrushing and drinking habits. Hypersensitive and non-sensitive teeth were submitted to tactile and ice stick stimuli. Then, the subjects marked their pain level in the visual analogue (VAS), numeric scale (NS), faces pain scale (FPS) and verbal evaluation scale (VES). DH was also assessed by Schiff scale (SS). The data were analyzed by Wilcoxon and Chi-Square tests, as well as by ROC curve. The mean age of the sample (56 women, 16 men) was 27.8 years. The most prevalent acidic beverage was coffee (36.0%) and the most preferred scale was the NS (47.2%). The pain level was statistically higher in teeth with DH compared to teeth without DH (p < 0.05). The accuracy ranged from 0.729 (SS) to 0.750 (NS). The highest sensitivity value was 81.9% for NS. The SS presented the highest specificity (91%). The visual analog, numerical, verbal evaluation, faces pain, and Schiff scales were accurate for DH diagnosis. The Schiff scale was the preferred scale for DH assessment.

Neck circumference cutoff points to identify excess android fat / Pontos de corte do perímetro do pescoço para identificar o excesso de gordura androide

Abstract Objective: To evaluate the ability of neck circumference to identify excess android fat and to propose cutoff points for Brazilian children. Method: This was a cross-sectional study with 376 children aged 8 and 9 years enrolled in public and private schools in the urban area of the municipality of Viçosa, Minas Gerais. A semi-structured questionnaire containing sociodemographic and lifestyle information was applied. The following were collected: neck circumference, weight, and height for the calculation of body mass index. The percentage of fat in the android region was determined by dual energy X-ray absorptiometry. Linear regression analysis was used to evaluate the association between neck circumference and android fat, adopting a significance level of 5%. Receiver operating characteristic curves were used to evaluate the capacity of neck circumference to determine the excess android fat, as well as to estimate the cutoff points of neck circumference according to gender. Results: Multiple linear regression showed an association between neck circumference and android fat (β: 2.94, 95% CI: 2.41, 3.47). Neck circumference was able to identify excess android fat in girls (AUC: 0.909, 95% CI: 0.999, 0.945) and boys (AUC: 0.938, 95% CI: 0.892, 0.968). The proposed cutoff points showed satisfactory sensitivity, specificity, and predictive values. Conclusions: Neck circumference is capable of identifying excess android fat in children and can be used in clinical practice and in population studies to determine central adiposity. The proposed cutoff points were satisfactory, but should be validated for other populations.

Resumo Objetivo: Avaliar a capacidade do perímetro do pescoço em identificar o excesso de gordura androide e propor pontos de corte para crianças brasileiras. Método: Estudo transversal com 376 crianças de oito e nove anos, matriculadas em escolas públicas e privadas da área urbana de Viçosa, Minas Gerais. Foi aplicado um questionário semiestruturado com informações sociodemográficas e de estilo de vida. Foram coletados: perímetro do pescoço, peso e estatura para o cálculo do índice de massa corporal. O percentual de gordura na região androide foi determinado pela absorciometria de raios X de dupla energia. A análise de regressão linear foi utilizada para avaliar a associação entre o perímetro do pescoço e a gordura androide, adotando-se o nível de significância de 5%. Por meio das curvas Receiver Operating Characteristic avaliou-se a capacidade do perímetro do pescoço de determinar o excesso de gordura androide, bem como estimaram-se os pontos de corte de perímetro do pescoço segundo o sexo. Resultados: A regressão linear múltipla demonstrou associação entre o perímetro do pescoço e a gordura androide (β: 2,94; IC95%: 2,41; 3,47). O perímetro do pescoço foi capaz de identificar o excesso de gordura androide em meninas (AUC: 0,909; IC95%: 0,859; 0,945) e meninos (AUC: 0,938; IC95%: 0,892; 0,968). Os pontos de corte propostos tiveram valores de sensibilidade, especificidade e preditivos satisfatórios. Conclusões: O perímetro do pescoço é uma medida capaz de identificar o excesso de gordura androide em crianças, pode ser usado na prática clínica e em estudos populacionais para determinar a adiposidade central. Os pontos de corte propostos foram satisfatórios, entretanto devem ser validados para outras populações.

Sensitivity and Specificity of Cephalometric Measures for the Diagnosis of Sagittal Skeletal Malocclusion

Objective: To evaluate and compare sensitivity and specificity of ANB, Wits, APDI and AF-BF to diagnose sagittal skeletal malocclusions, in children between 6 to 12 years old, using ROC curves, a widely accepted method for the analysis and evaluation of diagnostic tests. Material and Methods: A descriptive-comparative study of diagnostic tests was conducted. From a population of 3,000 children, a non-probabilistic sample of 209 was selected. The clinical classification of the patients as class I, II or III, made by a group of experts based on the visual inspection of models and photographs, was chosen as the gold standard. After calibration (ICC>0.94) the variables were measured in cephalograms. Eight ROC curves were plotted (I vs II, and I vs III for each one of the variables). The area under the curve was measured and compared (Ji-square test). Cut points were established. Results: To discriminate Class I from II, ANB showed the largest area under the curve (AUC) (0.876) and the cut point (best sensitivity and specificity) was at 5.75°. To discriminate class I from III, Wits showed the largest AUC (0.874) with a cut point of -3.25 mm. There were no statistical differences between the AUC for the four variables (p=0.48 y p=0.38 for class I-II and I-III). Conclusion: ANB and Wits performed better for the diagnosis of class II and III, respectively. Cut points in children were different from those reported in adults.

Índices de gravidade do trauma: capacidade preditiva para admissão e mortalidade de pacientes na unidade de terapia intensiva de um hospital privado / Trauma Severity Indices: Predictive capacity for admission and mortality of patients in the intensive care unit of a private hospital

Introdução: há muito tempo se discute a definição do nível de gravidade do trauma, o qual pode ser determinado por índices de trauma. Atualmente, existem diversos índices na literatura que, em sua maioria, analisam a probabilidade de sobrevida (Ps) das vítimas de trauma. Entretanto, são escassos os estudos que utilizam os índices de trauma como preditores de admissão e mortalidade de traumatizados em Unidade de Terapia Intensiva (UTI), o que justifica a relevância desta pesquisa. Objetivo: avaliar a capacidade dos índices de gravidade do trauma na predição de admissão e mortalidade na UTI de doentes traumatizados. Método: coorte retrospectiva realizada por meio da análise de prontuários de pacientes atendidos entre 2014-2017 em hospital privado de São Paulo. Os critérios de inclusão dos doentes foram: ser vítima de trauma contuso ou penetrante, ter idade 18 anos e ser admitido no hospital em até 24 horas do evento traumático. Foram analisados os índices Revised Trauma Score (RTS), New Trauma Score (NTS), Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma and Injury Severity Score (TRISS), New Trauma and Injury Severity Score (NTRISS), Base-deficit Injury Severity Score (BISS) e Base- deficit and New Injury Severity Score (BNISS). Os testes Qui-Quadrado de Pearson, Exato de Fisher, Wilcoxon-Mann-Whitney e Brunner-Munzel, além de Receiver Operating Characteristic Curves e área sob a curva (AUC) foram utilizados nas análises (nível de significância de 5%). Resultados: a casuística foi composta por 747 pacientes, a maioria do sexo feminino (52,5%) e média de idade de 51,5 (±21,3) anos. O mecanismo de trauma contuso (89,4%) e as quedas (36,1%) prevaleceram. As médias do RTS, NTS, mREMS, ISS e NISS foram 7,8 (±0,3), 10,5 (±0,5), 2,1 (±2,3), 3,4 (±5,5) e 4,3 (±7,1), respectivamente. A média da Ps indicada pelos índices TRISS e NTRISS superou 98,0%. O BNISS apresentou menor média (78,8%) de Ps que o BISS (82,9%). Um total de 106 pacientes foi admitido na UTI. Houve diferença significativa (p<0,050) entre os grupos (pacientes admitidos versus não admitidos na UTI) em relação às variáveis sexo, idade, mecanismo do trauma, causa externa, atendimento pré-hospitalar e gravidade segundo RTS, NTS, mREMS, ISS, NISS, TRISS e NTRISS. Os índices ISS (AUC 0,919) e NISS (AUC 0,916) apresentaram melhor capacidade preditiva para admissão dos pacientes na UTI. A análise comparativa dos grupos (100 sobreviventes e 6 não sobreviventes na UTI) mostrou diferença significativa (p<0,050) entre eles em relação aos índices NTS, mREMS, ISS, NISS, TRISS, NTRISS, BISS e BNISS. O NISS (AUC 0,949), TRISS (AUC 0,909), NTRISS (AUC 0,967), BISS (AUC 0,902) e BNISS (AUC 0,976) apresentaram excelente desempenho na predição de mortalidade dos pacientes da UTI. Conclusão: os índices anatômicos apresentaram melhor capacidade preditiva para admissão na UTI. Em relação à mortalidade, o NISS e os índices mistos tiveram os melhores desempenhos. Por fim, aplicar o índice de trauma mais assertivo para admissão e mortalidade na UTI tem potencial para auxiliar os profissionais em processos decisórios sobre alocação de recursos e estratégias para melhoria da qualidade da assistência aos pacientes.

Introduction: Historically, we defined the severity level of trauma using trauma indices. Currently, several indices in the literature analyze the probability of survival (Ps) of trauma victims. However, there are few studies that use trauma indices as predictors of the admission and mortality of traumatized patients in the intensive care unit (ICU), which justifies the relevance of this research. Objective: to evaluate the ability of trauma severity indices to predict admission and mortality of trauma patients in the ICU. Method: a retrospective cohort study conducted through the analysis of medical records of patients attended between 20142017 in a private hospital in São Paulo. The inclusion criteria for patients were being a victim of blunt or penetrating trauma, aged 18 years and admitted to the hospital within 24 hours of the traumatic event. We analyzed the following indices: Revised Trauma Score (RTS), New Trauma Score (NTS), modified Rapid Emergency Score (mREMS), Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma and Injury Severity Score (TRISS), New Trauma and Injury Severity Score (NTRISS), Base-Deficit Injury Severity Score (BISS) and Base-Deficit and New Injury Severity Score (BNISS). Pearsons chi-squared, Fishers exact, Wilcoxon-Mann-Whitney and Brunner-Munzel tests, in addition to Receiver Operating Characteristic Curves and area under the curve (AUC), were used in the analysis (significance level of 5%). Results: The sample consisted of 747 patients, 52.5% females, with a mean age of 51.5 (± 21.3) years. The blunt trauma (89.4%) and falls (36.1%) prevailed. The averages of the index scores were as follows: RTS, 7.8 (±0.3), NTS, 10.5 (±0.5), mREMS, 2.1 (±2.3), ISS, 3.4 (±5.5) and NISS, 4.3 (±7.1). The mean Ps indicated by the TRISS and NTRISS indices exceeded 98.0%. The BNISS showed a lower mean (78.8%) of Ps than BISS (82.9%). A total of 106 patients were admitted to the ICU. There was a significant difference (P < .050) between the groups (patients admitted vs not admitted to the ICU) in relation to the variables gender, age, mechanism of trauma, external cause, pre-hospital care and severity according to RTS, NTS, mREMS, ISS, NISS, TRISS and NTRISS. The ISS (AUC 0.919) and NISS (AUC 0.916) indices presented better predictive capacity for ICU patient admission. The comparative analysis of the groups (100 survivors and 6 non-survivors in the ICU) showed a significant difference (p<.050) between them in relation to the NTS, mREMS, ISS, NISS, TRISS, NTRISS, BISS and BNISS indices. The NISS (AUC 0.949), TRISS (AUC 0.909), NTRISS (AUC 0.967), BISS (AUC 0.902) and BNISS (AUC 0.976) presented excellent performance in predicting the mortality of ICU patients. Conclusion: the anatomical indices presented better predictive capacity for ICU admission. In relation to mortality, NISS and the mixed indices had the best performances. Finally, applying the most assertive trauma index for admission and mortality in the ICU has the potential to help professionals in decision-making processes about resource allocation and strategies to improve the quality of patient care.

Evaluation of three radiographic methods for detecting occlusal caries lesions

Aim: To compare, in vitro, the performance of three radiographic methods for the detection of occlusal caries in permanent teeth. Methods: A total of 96 extracted molars with no apparent occlusal cavitation were selected, they were photographed and radiographed under standardized conditions using conventional E-plus films and two digital systems, CDR and Sidexis. Two examiners analyzed all films and images, recording the presence and lesion depth. One quarter of the teeth were re-examined for intra- and interexaminer agreements. The teeth were subsequently bisected and examined under a stereomicroscope. The intra and interexaminer agreements and the diagnostic performance (sensitivity, specificity, accuracy and the area under receiver operating characteristic, ROC curve) of each method were evaluated. Results: Out of 96 occlusal surfaces, 41 were sound, 31 had lesions in enamel, and 24 had dentin lesions. Weighted Kappa values for intraexaminer agreement varied widely, depending on both the observer and method. The interexaminer agreement was higher for the digital images than for the conventional films. The area under the ROC curve for enamel and dentin caries (at D1 diagnostic threshold) was 0.55 for films, 0.60 for Schick and 0.54 for Sirona, which were not significantly different from each other. Conclusions: Digital images presented better results of interexaminer agreement; however, no additional effect in the diagnostic performance could be observed in comparison to conventional films.