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High PPV (high + ppv)
Selected AbstractsClinical impact (cost-effectiveness) of qualifying atypical squamous cells of undeterminate significance (ASCUS) in cases favoring a reactive or dysplastic processDIAGNOSTIC CYTOPATHOLOGY, Issue 1 2003F.M. Carozzi Ph.D. Abstract The cost-effectiveness of qualifying ASCUS cases into two different subcategories, favoring a reactive (ASCUS-R) or dysplastic process (ASCUS-S), was evaluated at the Centro per lo Studio e la Prevenzione Oncologica of Florence in a prospective study. The study determined the positive predictive value (PPV) for histologically confirmed cervical intraepithelial neoplasia grade 2 (CIN2) or more (CIN>) severe lesion of the two ASCUS subgroups. ASCUS-S had a PPV (10.78%) comparable to low-grade squamous intraepithelial lesions (LSIL) (11.40%). For ASCUS-R cases, the recommendation of 6-mo repeat cytology prompting colposcopy in cases of persistent ASCUS or more severe cytology was also effective, as it selected a subgroup with a relatively high PPV (10.34%). The cost-effectiveness of a protocol based on ASCUS qualification was compared with two other possible options for nonqualified ASCUS cases: immediate colposcopy and colposcopy in persistent ASCUS at 6-mo repeat cytology.. The detection rate of CIN2> was substantially higher using ASCUS qualification (35.9 vs 14.8 or 17.1). The cost per ASCUS subject was ,24.99, 27.11, or 25.14 and that per CIN2> detected was ,697, 1,831 or 1,470 for the three options, respectively. The evidence that ASCUS detection option implies a higher detection rate of CIN2> and subsequently a lower cost per CIN2> detection must be considered with caution and deserves confirmation by other comparative studies. Diagn. Cytopathol. 2003;29:4,7. © 2003 Wiley-Liss, Inc. [source] Review article: the role of rapid virological response in determining treatment duration for chronic hepatitis CALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2010F. F. POORDAD Aliment Pharmacol Ther,31, 1251,1267 Summary Background, For patients with chronic hepatitis C, attaining rapid virological response (RVR) is highly predictive of attaining SVR. Aim, To consider the predictive value of RVR in terms of SVR and relapse. Methods, Data were collected from published clinical trials to define the predictive value of RVR for SVR and evaluate the proposed continuum linking RVR to relapse. Results, These data support a 24-week regimen among genotype (G)1 patients who attain RVR with positive predictive values (PPVs) of 77.8% and 85.7% in patients with G1 infection treated for 24 and 48 weeks. Conversely, failure to attain RVR among G1 patients should not be viewed as a criterion for extending treatment duration beyond 48 weeks: negative predictive values (NPVs) were 60.9% and 52.7% in G1 patients without RVR treated for 48 and 72 weeks. Among G2/3 patients, RVR has a high PPV; however, the NPV varied with treatment duration indicating that a 24-week treatment regimen is warranted in G2/3 patients who fail to attain RVR. Conclusions, The present analysis confirms RVR as a strong predictor of SVR that can be used to tailor treatment duration, but which also should be appreciated in the context of treatment duration and regimen. [source] Recurrent hepatitis C after liver transplantation: On-treatment prediction of response to peginterferon/ribavirin therapyLIVER TRANSPLANTATION, Issue 1 2008Ibrahim A. Hanouneh Sustained virologic response (SVR) in the treatment of recurrent hepatitis C virus (HCV) infection after liver transplantation (LT) remains suboptimal. We evaluated efficacy of pegylated interferon alfa (PEG) and ribavirin (RBV) (PEG/RBV) combination therapy in LT recipients with recurrent HCV and predictive values of rapid virological response (RVR) and early virologic response (EVR). Between January 2001 and October 2005, LT recipients with recurrent HCV were intended to be treated for 48 weeks with PEG/RBV combination therapy independent of genotype or virologic response [53 patients (79% genotype 1)]. On-treatment predictor of response at week 4 (RVR) was defined as undetectable HCV RNA, and at week 12 (EVR) as undetectable HCV RNA or a >2 log10 drop from pretreatment viral load. SVR was seen in 19 (35%) patients. Patients with genotype 2/3 were more likely to achieve SVR than those with genotype 1 (87% versus 23%; P = 0.001). The highest rate of SVR was seen in patients with RVR [specificity and positive predictive value (PPV) = 100%] while the highest rate of treatment failure was seen in those who did not have EVR [sensitivity and negative predictive value (NPV) = 100%]. The NPV of RVR to identify those who will not achieve SVR was also very high (88%). EVR had low PPV (63%) to identify those with SVR. In conclusion, PEG/RBV combination therapy is effective in the treatment of post-LT recurrent HCV. On-treatment virologic monitoring is highly predictive of SVR and may optimize the virologic response and minimize toxicity. Given its high PPV and NPV, RVR appears to be the most appropriate decision time point for continuation of therapy. Liver Transpl 14:53,58, 2008. © 2007 AASLD. [source] Positive predictive value of ICD-9 codes 410 and 411 in the identification of cases of acute coronary syndromes in the Saskatchewan Hospital automated databasePHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2008Cristina Varas-Lorenzo MD Abstract Background Case definitions are essential to epidemiological research. Objectives To evaluate ICD-9 codes 410 and 411 to identify cases of acute coronary syndromes (ACS), and the clinical information availability in the administrative and hospital discharge records of Saskatchewan, Canada. Methods In the context of a safety cohort study, we identified hospitalisations with primary discharge codes 410 (2260) and 411 (799). We selected all records with code 411, and a random sample (200) with code 410. Based on information obtained by trained abstractors from hospital records, events were classified by two cardiologists as definite or possible according to adapted AHA/ESC criteria. The validity of 410 and 411 codes was assessed by calculating the positive predictive value (PPV). Completeness of the recorded information on risk factors and use of aspirin was explored. Results The PPVs of the codes 410 and 411 for ACS were 0.96 (95%CI: 0. 92,0.98) and 0.86 (95%CI: 0.83,0.88), respectively. The PPV of 410 for acute myocardial infarction (AMI) was 0.95 (95%CI: 0.91,0.98). The PPV of 411 was 0.73 (95%CI: 0.70,0.77) for primary unstable angina (UA) and 0.09 (95%CI: 0.07,0.11) for AMI. Hospital charts review revealed key information for clinical variables, smoking, obesity and use of aspirin at admission. Conclusions ICD-9 410 code has high PPV for AMI cases, likewise 411 for UA cases. Case validation remains important in epidemiological studies with administrative health databases. Given the pathophysiology of ACS, both AMI and UA might be used as study end points. In addition to code 410, we recommend the use of 411 plus validation. Copyright © 2008 John Wiley & Sons, Ltd. [source] The "Consecutive Combined Test",using Double test from week 8 + 0 and Nuchal Translucency Scan, for first trimester screening for Down SyndromePRENATAL DIAGNOSIS, Issue 12 2006Kirsten Marie Schiøtt Abstract Objective To test the performance of the "Consecutive Combined Test", applied on a high-risk population. The classic "Combined Test" (Double test (DT) and Nuchal Translucency (NT) measurement on the same day at app. week 12) gives detection rates (DR) for Down syndrome (DS) of 80,90% for false positive rates (FPR) of 5%. In affected pregnancies, however, the low PAPP-A level is more pronounced, the earlier in pregnancy. Thus, we hypothesized that the Double Test could be taken as early as from week 8 + 0, without compromising the excellent performance of the Combined Test. This "Consecutive Combined Test" allows for a centralised laboratory function. Methods Inclusion criteria were maternal age > 35 years (80%) or a family history (20%). Double test was taken at a median gestational age (GA) = 10 weeks. NT was measured at GA = 11 + 0 , 13 + 6. A combined risk estimate of > 1:400 at birth was used as cut-off. Results 881 had the full test. Screen positive = 34. CVS with aneuploidy = 11 (6 trisomy-21, 5 others). FPR = 3.2%. Positive Predictive Value (PPV) = 17.6% for T-21. Conclusion The "Consecutive Combined Test" applied on a high-risk population seems to be highly efficient with a remarkably high PPV. Copyright © 2006 John Wiley & Sons, Ltd. [source] | ||||||||||