Home About us Contact
|
Home About us Contact | ||
|
|
||
Diagnostic Validity (diagnostic + validity)
Selected AbstractsObsessive,compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V,DEPRESSION AND ANXIETY, Issue 6 2010James F. Leckman M.D. Abstract Background: Since the publication of the DSM-IV in 1994, research on obsessive,compulsive disorder (OCD) has continued to expand. It is timely to reconsider the nosology of this disorder, assessing whether changes to diagnostic criteria as well as subtypes and specifiers may improve diagnostic validity and clinical utility. Methods: The existing criteria were evaluated. Key issues were identified. Electronic databases of PubMed, ScienceDirect, and PsycINFO were searched for relevant studies. Results: This review presents a number of options and preliminary recommendations to be considered for DSM-V. These include: (1) clarifying and simplifying the definition of obsessions and compulsions (criterion A); (2) possibly deleting the requirement that people recognize that their obsessions or compulsions are excessive or unreasonable (criterion B); (3) rethinking the clinical significance criterion (criterion C) and, in the interim, possibly adjusting what is considered "time-consuming" for OCD; (4) listing additional disorders to help with the differential diagnosis (criterion D); (5) rethinking the medical exclusion criterion (criterion E) and clarifying what is meant by a "general medical condition"; (6) revising the specifiers (i.e., clarifying that OCD can involve a range of insight, in addition to "poor insight," and adding "tic-related OCD"); and (7) highlighting in the DSM-V text important clinical features of OCD that are not currently mentioned in the criteria (e.g., the major symptom dimensions). Conclusions: A number of changes to the existing diagnostic criteria for OCD are proposed. These proposed criteria may change as the DSM-V process progresses. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source] Administrative registers in psychiatric research: a systematic review of validity studiesACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2005N. Byrne Objective:, To conduct a systematic review of studies investigating the validity of administrative registers for use in psychiatric research. Method:, Studies were identified using MEDLINE (1966,2004) and EMBASE (1980,2004) databases using keywords ,validity' or ,reliability' combined with ,register' or ,database$'. Studies reviewed by two raters blind to each other and quality assessed using a data extraction form devised by the authors. A narrative description of the findings is presented. Results:, Fourteen studies were identified, seven of which concerned Scandinavian registers. Ten studies were solely concerned with diagnostic validity and the most common single diagnosis studied was schizophrenia (five studies). Methods used and study quality varied widely. Conclusion:, Given the importance of the area, relatively little high-quality work exists into systematically measuring the diagnostic data validity of registers for research purposes. [source] Detection of Delirium by Bedside Nurses Using the Confusion Assessment MethodJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2006Joke Lemiengre RN A prospective, descriptive study was used to assess the diagnostic validity of the Confusion Assessment Method (CAM) administered at the bedside by nurses in daily practice. Two different scoring methods of the CAM (the specific (SPEC) and sensitive (SENS) methods) were compared with a criterion standard (CAM completed by trained research nurses). During a 5-month period, all patients consecutively admitted to an acute geriatric ward of the University Hospitals of Leuven (Belgium) were enrolled in the study. The 258 elderly inpatients who were included underwent 641 paired but independent ratings of delirium by bedside and trained research nurses. Delirium was identified in 36 of the 258 patients (14%) or in 42 of the 641 paired observations (6.5%). The SENS method of the CAM algorithm as administered by bedside nurses had the greatest diagnostic accuracy, with 66.7% sensitivity and 90.7% specificity; the SPEC method had 23.8% sensitivity and 97.7% specificity. Bedside nurses had difficulties recognizing the features of acute onset, fluctuation, and altered level of consciousness. For both scoring methods, bedside nurses had difficulties with the identification of elderly patients with delirium but succeeded in diagnosing correctly those patients without delirium in more than 90% of observations. Given these results, additional education about delirium with special attention to guided training of bedside nurses in the use of an assessment strategy such as the CAM for the recognition of delirium symptoms is warranted. [source] Refining diagnoses: applying the DC-LD to an Irish population with intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2005A. Felstrom Abstract Background The diagnostic criteria for psychiatric disorders for use with adults with learning disabilities/mental retardation (DC-LD) is a diagnostic tool developed in 2001 to improve upon existing classification systems for adults with learning disability. The aim of this study was to apply the classification system described by the DC-LD to a residential intellectual disability (ID) population to examine whether it improved our diagnostic understanding of residents. Methods Chart reviews of 113 of 178 people in a residential ID service were conducted. For each resident, information was recorded according to the DC-LD multi-axial system. Each resident's case was then discussed with a member of nursing staff familiar with the resident. If diagnosis was unclear, the case was discussed with a senior clinical psychiatrist. Results The percentage of residents with a moderate to profound ID was 87.6%. In total, 94 diagnoses of psychiatric illness (Axis III, Level B, DC-LD) were made. Of those 94 diagnoses, seven new diagnoses were found because of DC-LD criteria. Of the total number of psychiatric diagnoses made, 72.3% were non-specific, residual category diagnoses. A total of 79 residents (69.9%) had at least one behaviour problem diagnosed on Axis III, Level D, Problem behaviours. Fifty-six (49.6%) of residents in this sample had co-morbid epilepsy. Conclusions In people with moderate to profound learning disabilities, diagnosis continues to be challenging. The DC-LD is a useful tool in helping to clarify diagnoses in this population by providing revised criteria and a system to classify problem behaviours. The DC-LD would be more helpful if specific axes were included to document medical and psychosocial problems independently from other diagnoses. Further research is warranted to determine whether the DC-LD hierarchical approach to diagnosis improves diagnostic validity. [source] Ethnicity affects the diagnostic validity of alpha-fetoprotein in hepatocellular carcinomaASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 2-3 2005Amal GAD Abstract Introduction: Hepatocellular carcinoma (HCC) is the fourth most common cancer worldwide with a high morbidity and mortality. Alpha-fetoprotein (AFP) is considered the main tumor marker for HCC diagnosis, but the variation in its diagnostic validity among studies justifies further investigation of the underlying contributing factors. Ethnic difference could be one of the factors that has not been well studied. We aimed at investigating the ethnic difference in AFP validity between Egyptian (representing Arabic North African) and Japanese (representing Asian) for HCC diagnosis. Methods: Four cohorts with chronic liver diseases (CLD) were studied: 171 Egyptian (65 HCC/106 non-HCC), and 173 Japanese (45 HCC/128 non-HCC). Laboratory tests including serum AFP, protein-induced vitamin K deficiency or absence (PIVKA-II), alanine aminotransferase (ALT), total bilirubin, platelet count, HBsAg, anti-HCV, and HCV core antigen were conducted using standard commercially available assays. Results: A significantly higher sensitivity of AFP in Egyptian in comparison with Japanese for HCC diagnosis (99 vs 67%, P < 0.001) was observed using an AFP cut-off point of 10 ng/mL, with a comparable specificity, (75,vs, 82%), While, a, sensitivity, of, 98, versus, 56%,,P < 0.001, and, a, specificity, of, 83, versus, 89% was found for AFP cut-off point of 20 ng/mL, respectively. The area under the receiver operating characteristic curve (ROC) was found to be 0.98 (95%CI = 0.969,0.997) for Egyptian and 0.77 (95%CI = 0.686,0.864) for Japanese. The highest sensitivity for the former group occurred at AFP = 20.5 ng/mL and at AFP = 10.2 ng/mL for the latter. Univariate analysis showed no effect for age, sex, underlying liver disease, cirrhosis, Child's class or tumor characteristics (size, pathological grade) on AFP sensitivity, while race significantly contributed to the higher sensitivity among Egyptians in comparison with the Japanese. Using ROC analysis, the AFP cut-off point for HCC detection in each subgroup of patients with and without each of the risk factors of interest was determined and the subgroups were again subclassified according to AFP positivity (< or , the decided cut-off point for each group). Logistic regression analysis of those factors combined showed that Egyptian ethnicity with an AFP level >20.5 ng/mL (P = 0.007), older age (>50 years) with an AFP level >26 ng/mL (P = 0.010), and cirrhosis with an AFP level >10.5 ng/mL (P = 0.014) were the independent risk factors for HCC. Conclusion: There is an ethnic variation in AFP validity between Egyptian and Japanese patients with a significantly lower sensitivity in the latter. Alpha-fetoprotein should not be the only marker used for screening HCC among Asian Japanese and younger age groups (<50 years) with CLD. In addition, an AFP cut-off point of 20 ng/mL is recommended when screening patients of Asian origin for HCC. [source] Simultaneous sodium lauryl sulphate testing improves the diagnostic validity of allergic patch tests.BRITISH JOURNAL OF DERMATOLOGY, Issue 4 2005Results from a prospective multicentre study of the German Contact Dermatitis Research Group (Deutsche Kontaktallergie-Gruppe Summary Background, There is evidence that a higher skin susceptibility may induce nonspecific erythematous or weak positive reactions to contact allergens in patch testing. Objectives, To evaluate whether simultaneous application of sodium lauryl sulphate (SLS) along with diagnostic patch tests with contact allergens can provide information regarding skin irritability which may help to discriminate allergic from nonspecific irritant reactions to contact allergens. Methods, Between July 2001 and June 2003, this prospective study collected patch test data of 5971 patients from 19 centres in Germany and Austria in the Information Network of Departments of Dermatology (IVDK). In addition to contact allergens (standard series and eight known ,problematic' allergens with a low reaction index and a high positivity ratio: 1,3-diphenylguanidine, amerchol L-101, benzalkonium chloride, benzoyl peroxide, cocamidopropyl betaine, octyl gallate, phenyl mercuric acetate and propylene glycol), patches with SLS 0·5% and 0·25% aq. were applied. Reactions to the allergens and to SLS were analysed at the IVDK data centre. The association between an erythematous or positive reaction to a certain allergen and an irritant reaction to SLS was assessed with logistic regression analysis, at the same time controlling for the influence of age and sex. Results, Of the 29 allergens of the standard series, 23 and 21 gave a higher percentage of nonspecific erythematous reactions in patients with an irritant reaction to 0·25% and 0·5% SLS, respectively, in comparison with SLS-negative patients. All eight ,problematic' allergens gave an increased percentage of nonspecific erythematous reactions. Similarly, 22 and 21 allergens of the standard series gave a higher percentage of positive allergic reactions in patients with an irritant reaction to 0·25% and 0·5% SLS, respectively, and seven of the eight ,problematic' allergens gave a higher percentage of positive allergic rections (exception: octyl gallate). For most allergens, the markers of skin reaction (reaction index and positivity ratio) were worse in SLS-positive patients. Differences were more pronounced when testing with SLS 0·25% than with SLS 0·5%. Conclusions, Because there is a convincing association between skin irritability (evaluated by SLS test) and the degree of skin reaction to contact allergens, the SLS test may help in deciding whether a doubtful erythematous or weakly ,positive' skin reaction should be interpreted as allergic or irritant. [source] Sensitivity and specificity of a visual acuity screening protocol performed with the Lea Symbols 15-line folding distance chart in preschool childrenACTA OPHTHALMOLOGICA, Issue 6 2006Francesca Bertuzzi Abstract. Purpose:, The aim of this study was to assess the feasibility of a visual acuity (VA) test using the Lea Symbols 15-line folding distance chart and its diagnostic validity in detecting VA deficiency in preschool children. Methods:, A group of 149 children aged 38,54 months underwent VA examination performed with the Lea 15-line folding optotype at a distance of 3 metres, according to a test protocol described in the Methods section. After the VA test, a complete ophthalmological examination, including cycloplegic retinoscopy, a cover test and examination of the anterior and posterior segments, was performed on each child in order to detect any VA-threatening ocular abnormality. The Lea Symbols test's sensitivity, specificity, positive and negative likelihood ratios (LR +, LR ,) and the receiver operating characteristic (ROC) curve were calculated by means of standard procedures using each VA level of the chart from 0.1 to 1 (1,0 logMAR) as a cut-off point. Results:, The Lea Symbols test could be successfully used in 95.9% of the population. The most useful cut-off points for screening preschool children were found to be 0.8 (LR +,5.73, LR ,,0.05) or 0.63 (LR +,11.7, LR ,,0.23). Conclusion:, The Lea Symbols test proved to be clinically useful in detecting VA deficiency in preschool children. The choice between the two best performing cut-off levels should be made according to the expected cost-effectiveness of the screening programme. [source] Behavioral and learning problems in schoolchildren related to cognitive test dataACTA PAEDIATRICA, Issue 7 2004FR Volkmar The interface between disorders of learning and development and disorders of behavior presents challenges for researchers and clinicians alike. In the Elk et al. paper, a large group of children were screened for learning and/or behavioral problems. A relatively large number of children screened positive and their IQ scores were analyzed using a cluster analytic approach. Various patterns were identified including lower and higher functioning children. In our commentary, we point out the challenges for diagnosis of mental health problems in both lower and higher functioning children; the potential overlap of problems in learning and social interaction remains an area in need of additional work. Conclusion: There is a complex interaction between developmental status and behavioral difficulty; further research is needed to clarify diagnostic validity and areas where existing diagnostic systems need further refinement. [source] | ||||||||||