scholarly journals Clinical effectiveness of the Manchester Glaucoma Enhanced Referral Scheme

2018 ◽  
Vol 103 (8) ◽  
pp. 1066-1071 ◽  
Author(s):  
Patrick J G Gunn ◽  
Joanne R Marks ◽  
Evgenia Konstantakopoulou ◽  
David F Edgar ◽  
John G Lawrenson ◽  
...  
Keyword(s):  
Usual Care ◽  
False Positive ◽  
False Negative ◽  
Clinical Effectiveness ◽  
Outcome Data ◽  
Reference Standard ◽  
Referral Criteria ◽  
Standard Assessment ◽  
The Uk

BackgroundGlaucoma referral filtering schemes have operated in the UK for many years. However, there is a paucity of data on the false-negative (FN) rate. This study evaluated the clinical effectiveness of the Manchester Glaucoma Enhanced Referral Scheme (GERS), estimating both the false-positive (FP) and FN rates.MethodOutcome data were collected for patients newly referred through GERS and assessed in ‘usual-care’ clinics to determine the FP rate (referred patients subsequently discharged at their first visit). For the FN rate, glaucoma suspects deemed not requiring referral following GERS assessment were invited to attend for a ‘reference standard’ examination including all elements of assessment recommended by National Institute for Health and Care Excellence (NICE) by a glaucoma specialist optometrist. A separate 33 cases comprising randomly selected referred and non-referred cases were reviewed independently by two glaucoma specialist consultant ophthalmologists to validate the reference standard assessment.Results1404 patients were evaluated in GERS during the study period; 651 (46.3%) were referred to the Hospital Eye Service (HES) and 753 (53.6%) were discharged. The FP rate in 307 assessable patients referred to the HES was 15.5%. This study reviewed 131 (17.4%) of those patients not referred to the HES through the GERS scheme; 117 (89.3%) were confirmed as not requiring hospital follow-up; 14 (10.7%) required follow-up, including 5 (3.8%) offered treatment. Only one patient (0.8%) in this sample met the GERS referral criteria and was not referred (true FN). There were no cases of missed glaucoma or non-glaucomatous pathology identified within our sample.ConclusionThe Manchester GERS is an effective glaucoma filtering scheme with a low FP and FN rate.

False Positive and False Negative Radon Measurement Results Due to Uncertainties in Seasonal Correction Factors

1994 ◽  
Vol 56 (1-4) ◽  
pp. 291-292 ◽  
Author(s):  
K.D. Cliff ◽  
J.C.H. Miles ◽  
S.P. Naismith
Keyword(s):  
False Positive ◽  
False Negative ◽  
Geometric Standard Deviation ◽  
Correction Factors ◽  
Radon Measurement ◽  
Negative Results ◽  
False Negative Results ◽  
Initial Survey ◽  
The Uk ◽  
Radon Measurements

Abstract Data from the UK national survey of radon in 2300 homes has been re-analysed to determine the uncertainty in seasonal correction factors applied to measurements of less than l year. The required correction factor for each six-month result was calculated from the known annual average for the appropriate home. The seasonal correction factors derived for each month were found to be approximately log-normally distributed, with an average geometric standard deviation of 1.36. Following this initial survey, radon measurements have been made in more than 80,000 homes in southwest England to determine whether they are above the UK radon Action level of 200 Bq.m-3. The measurements were carried out over three months in each case using etched track detectors in two locations in each home, and the results were corrected for the average seasonal variation found in the original UK study of radon in homes. Because of the uncertainty in the seasonal correction factors, households with between 130 and 300 Bq.m-3 were advised to have a second three-month measurement in a different season before deciding whether or not to take remedial action. More than 7000 homes were remonitored for this purpose. The results are analysed to show the number of false positive and false negative results that would have been reported if advice had been based solely on the initial measurement. It is shown that the present scheme results in extremely small numbers of false positive and false negative results.

An In-patient Behavioural Psychotherapy Unit

1991 ◽  
Vol 158 (3) ◽  
pp. 362-367 ◽  
Author(s):  
Graham Thornicroft ◽  
Louise Colson ◽  
Isaac Marks
Keyword(s):  
Social Adjustment ◽  
Outcome Data ◽  
Substantial Improvement ◽  
Response Prevention ◽  
Regional Basis ◽  
The Uk

An in-patient behavioural psychotherapy unit is described that emphasises self-treatment, teaching relatives to become cotherapists while resident in the unit, routine collection of outcome data, minimising use of medication, and absence of night nurses. Patients are referred from all over the UK, mostly with chronic disabling OCD. Treatment includes self-exposure and self-imposed response prevention. A year's cohort (52 patients) showed substantial improvement that consolidated during six-month follow-up (83% decrease in total ritual time per day, 58% fall in target ritual scores, better social adjustment), and families noted relief of burden; eight patients dropped out. Further such units are needed in the UK, perhaps on a regional basis; they could be run as specialist hostels.

UK trial of the Osseointegrated Prosthesis for the Rehabilitation for Amputees: 1995–2018

2018 ◽  
Vol 43 (1) ◽  
pp. 112-122 ◽  
Author(s):  
Douglas John Matthews ◽  
Mateen Arastu ◽  
Maggie Uden ◽  
John Paul Sullivan ◽  
Kristina Bolsakova ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Short Form ◽  
Deep Infection ◽  
Outcome Data ◽  
Superficial Infection ◽  
Kaplan Meier ◽  
The Uk ◽  
Implant System

Background: Amputation of a limb impacts on patients’ self-perception and quality of life. Prostheses directly anchored to the skeleton are being investigated, aiming to avoid soft tissue complications. Objectives: We report outcome data for the UK trial of the Osseointegrated Prosthesis for the Rehabilitation of Amputees Implant System with a minimum of 9-year follow-up. Methods: Eighteen transfemoral amputees received unilateral implants between 1997 and 2008. Five were implanted before a formalised protocol, called Osseointegrated Prosthesis for the Rehabilitation of Amputees, was developed. Mean follow-up of the Pre-Osseointegrated Prosthesis for the Rehabilitation of Amputees group is 11.4 years (1.8–18.6 years), while for the Post-Osseointegrated Prosthesis for the Rehabilitation of Amputees group it is 12.3 years (2.9–15.9). Results: The Kaplan–Meier cumulative survivorship is 40% for the Pre-Osseointegrated Prosthesis for the Rehabilitation of Amputees group and 80.21% for the Post-Osseointegrated Prosthesis for the Rehabilitation of Amputees group. Five implants (28%) have been removed, three (17%) for deep infection, one (5.6%) for chronic pain, later proven to be infected and one (5.6%) due to implant fracture secondary to loosening due to infection. Two patients (11%) have peri-implant infections suppressed with oral antibiotics. Eleven cases (61%) of superficial infection were successfully treated with antibiotics. 36-Item short-form health survey and Questionnaire for persons with a Transfemoral Amputation showed significant improvements in quality of life up to 5 years after implantation. Conclusion: This small cohort of patients demonstrates osseointegrated prosthesis allows prolonged usage and improves patients’ quality of life compared to conventional prostheses. Clinical relevance These prostheses may provide a future gold standard for amputees and this study provides the first outcome data over such a time period to be reported from outside of the developers group.

scholarly journals False Covid-19 Test Results – Could We Do Things Better? A Personal Opinion

2020 ◽  
Vol 8 (5) ◽  
Author(s):  
Suzanne Lisbeth Ekelund
Keyword(s):  
False Positive ◽  
False Negative ◽  
Test Results ◽  
Negative Results ◽  
False Negative Results ◽  
Personal Opinion ◽  
Potential Problems

This paper describes the problems with false covid-19 test results, both false positive and false negative results. The problems are related to the quality of tests, test sampling and the currently limited follow-up procedures. A test and follow-up strategy that could decrease the potential problems is suggested.

scholarly journals The UK INFINITY Study - Early Experience and Complications of a Multicenter series of 504 Total Ankle Arthroplasties.

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0008
Author(s):  
David N. Townshend ◽  
Rajesh Kakwani ◽  
Murty N. Aradhyula ◽  
John C. Mckinley ◽  
Hisham Shalaby ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Early Experience ◽  
Outcome Data ◽  
Patient Specific ◽  
Patient Specific Instrumentation ◽  
Early Revision ◽  
Significant Difference ◽  
The Uk

Category Ankle Arthritis; Ankle Introduction/Purpose: This is the first report from the UK INFINITY study. This is a multicentre, non-inventor, prospective observational study of 504 INFINITY fixed bearing total ankle arthroplasties. We report our early experience, complications, radiographic and functional outcomes of this prosthesis. Methods: Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiographic, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire and Euroquol 5D-5L) were collected preoperatively, at 6 months (454 patients), 1 year (328 patients) and 2 years (104 patients). The average age was 67.8 (range 23.9 to 88.5) and average BMI 29.9 (18.9 to 48.0). The COFAS grading system was used to stratify deformity. There were 259 (51.4%) COFAS Type 1, 122 (24.2%) COFAS Type 2, 32 (6.3%) COFAS 3 and 87 (17.3%) COFAS type 4. 38 patients (7.54%) presented with inflammatory arthritis. 101 (20.0%) of implantations utilised patient specific instrumentation (Prophecy). 169 (33.5%) of patients underwent an additional procedure at the time of surgery. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts and/or subsidence. Results: There was a significant (p<0.01) improvement across all functional outcome scores at 6 months, which was sustained at one and two years. There was no significant difference with the use of patient specific instrumentation. 167 (33.1%) underwent additional procedures at index surgery. At the latest follow up 3 implants (0.6%) have been revised. One patient at 6 weeks for deep infection, one patient at 6 months for subsidence and one patient at 18 months for loosening. There were an additional 13 reoperations (2.6%) at the latest follow up. Conclusion: The UK INFINITY study is the largest reported multicentre study of a Total Ankle Arthroplasty to date. This study has shown a low early revision rate and high functional outcomes of the INFINITY prosthesis.

scholarly journals The Confirmation Rate of Primary Hits: A Predictive Model

2002 ◽  
Vol 7 (3) ◽  
pp. 175-190 ◽  
Author(s):  
Paul Fogel ◽  
Pascal Collette ◽  
Alain Dupront ◽  
Tina Garyantes ◽  
Denis Guédini
Keyword(s):  
Predictive Model ◽  
False Positive ◽  
False Negative ◽  
Individual Compound ◽  
Additional Advantage ◽  
Primary Screening ◽  
Alternative Approach ◽  
Compound Screening ◽  
Calculated Probability

HTS data from primary screening are usually analyzed by setting a cutoff for activity, in order to minimize both false-negative and false-positive rates. An alternative approach, based on a calculated probability of being active, is presented here. Given the predicted confirmation rate derived from this probability, the number of primary positives selected for follow-up can be optimized to maximize the number of true positives without picking too many false positives. Typical cutoff-determining methods are more serendipitous in their nature and not easily optimized in an effort to optimize screening efforts. An additional advantage of calculating a probability of being active for each compound screened is that orthogonal mixtures can be deconvoluted without presetting a deconvolution threshold. An important consequence of using the probability of being active with orthogonal mixtures is that individual compound screening results can be recorded irrespective of whether the assays were performed on single compounds or on cocktails.

Assessment of the total cost of FNAC as a diagnostic tool in patients with thyroid nodules

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6628-6628
Author(s):  
I. Borget ◽  
P. Vielh ◽  
M. Allyn ◽  
M. Schlumberger ◽  
G. De Pouvourville
Keyword(s):  
False Positive ◽  
Thyroid Nodules ◽  
Unit Cost ◽  
False Negative ◽  
Final Diagnosis ◽  
Sensitivity Analyses ◽  
Markov Modelling ◽  
Total Cost ◽  
Number Of Patients

6628 Background: The prevalence of thyroid nodules in the general population ranges from 4 to 7% and fine-needle aspiration cytology (FNAC) is a widely used diagnostic procedure. As the final diagnosis is based on post-surgical pathology of the lesion, a number of patients with nodules classified as benign or indeterminate by cytology may have a postponed final diagnosis, impacting the procedure cost. This study aims to determine the total cost of FNAC, by taking into account of diagnostic mistakes (false-positive and false-negative), failures of FNAC (indeterminate results) and the follow-up of non operated patients. Methods: A Markov model was built to describe the management of patients through time, from the first FNA-t. We derived estimates for diagnostic accuracy values and follow-up from a retrospective study, including all patients who had their first FNAC from 2003 to 2005 at Institut Gustave Roussy. Costs were computed from the viewpoint of the hospital. A microcosting study was performed to determine the unit cost of FNAC. Sensitivity analyses were performed. Results: Out of the 624 patients who had FNAC, 15 were cytologically classified as malignant, 57 as suspicious and 171 as indeterminate. Surgical excision was carried on in 155 cases. The unit cost of FNAC was 121 €. Markov modelling showed that the mean total cost of a true diagnosis including unnecessary surgeries, repeat FNAC and follow-up was 1,145 Euros. The number of false negative and false positive cases had little impact on total cost, whereas it was significantly affected by the percentage (27%) of unsatisfactory specimens. The absence of such specimens would reduce the total cost to 738 Euros (35%). Conclusions: The cost of FNAC exceeds its unit production cost. It depends on the performance of the cytologist and on the rate of indeterminate results that might be reduced by routine ultrasound-guidance. No significant financial relationships to disclose.

Accuracy of Fine-Needle Aspiration of Thyroid

2001 ◽  
Vol 125 (4) ◽  
pp. 484-488 ◽  
Author(s):  
Mojghan Amrikachi ◽  
Ibrahim Ramzy ◽  
Sheldon Rubenfeld ◽  
Thomas M. Wheeler
Keyword(s):  
Fine Needle Aspiration ◽  
False Positive ◽  
Thyroid Nodules ◽  
False Negative ◽  
Cost Effective ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Follicular Variant ◽  
Fine Needle

Abstract Context.—Fine-needle aspiration has become an accepted and cost-effective procedure for rapid diagnosis of thyroid lesions. The routine use of fine-needle aspiration has reduced the rate of unnecessary surgery for thyroid nodules. Objectives.—To determine the accuracy of fine-needle aspiration biopsy diagnosis and to discuss the possible pitfalls. Design, Setting, and Participants.—Reports of 6226 fine-needle aspiration biopsies of the thyroid performed during a period of 16 years (1982–1998) were reviewed. Computerized reports of the fine-needle aspiration biopsies were sent to the physicians who performed the procedures, and clinical follow-up information regarding the patients was requested. Twenty-four clinicians participated in the study. Histologic diagnoses were available for 354 cases. The cytopathologic diagnoses were correlated with the histologic findings or clinical outcomes. Results.—The cytologic diagnoses were as follows: 210 (3.4%) malignant, 450 (7.2%) suspicious, 3731 (60%) benign, and 1845 (29.5%) unsatisfactory. Most of the cases with negative or unsatisfactory aspirates were followed clinically or by repeat fine-needle aspiration. We identified 11 false-negative and 7 false-positive diagnoses. For aspirates considered sufficient for diagnosis, the sensitivity and specificity levels were 93% and 96%, respectively. Conclusions.—Fine-needle aspiration of the thyroid gland is highly accurate and has a low rate of false-negative and false-positive diagnoses. The major diagnostic problems are caused by diagnosis using a marginally adequate specimen, diagnosis of malignancy based on just 1 or 2 atypical cytologic features, or overlapping cytologic features of follicular neoplasm with those of follicular variant of papillary carcinoma.

FDG-PET for Staging and Follow-up of HIV-Infected Patients with Non Hodgkin Lymphoma and Hodgkin Lymphoma: A Single Center Experience.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 5014-5014
Author(s):  
Silvia Cantoni ◽  
Erika Ravelli ◽  
Maria Cristina Moioli ◽  
Chiara Rusconi ◽  
Vittorio Ruggero Zilioli ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Ct Scan ◽  
Hodgkin Lymphoma ◽  
False Positive ◽  
Fdg Pet ◽  
False Negative ◽  
Hiv Positive ◽  
Number Of Patients ◽  
Positive Results

Abstract Abstract 5014 Introduction Risk of developing non Hodgkin lymphomas (NHL) is known to be increased among patients (pts) infected by HIV-1 and sporadic non-HIV related cases of Hodgking lymphomas (HL) are also described. HIV-positive pts also feature a virus-related systemic lymphoadenopathy which makes nodal involvement by lymphoma difficult to evaluate using conventional imaging. The role of positron-emission tomography using 18F-fluorodeoxyglucose (FDG-PET) in the staging and evaluation of response to treatment of pts with NHL and HL is well established in immunocompetent pts, while only limited information is available on lymphomas arising in the setting of HIV infection. We report on a retrospective analysis of FDG-PET results in a group of HIV pts with lymphoma, both NHL and HL, followed-up at our hospital. Patients and methods Twelve HIV-positive male pts with a diagnosis of lymphoma (7 high grade and 1 follicular NHL, 4 HL) underwent a total of 22 PET scans. PET results were compared with those obtained by computed tomography (CT). Nine PET were performed at staging, 7 at restaging following chemotherapy, and 6 at follow-up. At diagnosis of lymphoma: median CD4 count was 200 cells/mcL (range 98-451); HIV genome was undetectable in 5/9 pts, in the remaining 4 pts for whom the data was available viral loads ranged from 103 to 1,452,720 copies/mL; 10/12 pts were already receiving HAART, while the remaining 2 pts started treatment upon diagnosis of lymphoma. Results In the majority of cases (17/22 = 77%) results of PET, CT scan and clinical status were concordant, being diagnostic of either lymphoma presence (11/17) or absence (6/17). No false positive results were recorded at follow-up. In 5/22 cases (23%) PET and CT scan were discordant. In 4 cases PET yielded a false negative result; in 2 cases at diagnosis (2 pts with HL) and in 2 cases at follow-up (both in the pt with follicular lymphoma). In the remaining case, a PET-negative CT-positive adenopathy was demonstrated which proved to be reactive in nature at biopsy. Discussion Our results suggest that FDG-PET is useful in the evaluation of lymphoma in the setting of HIV infection, similarly to what has been observed among immunocompetent pts. Although the number of patients is limited, in our experience PET proved to be able to discriminate between reactive and lymphomatous involvement of lymphoid tissue as demonstrated by absence of false positive results in pts evaluated at follow-up. These results need to be confirmed by larger clinical trials. Disclosures No relevant conflicts of interest to declare.

Is there a need for rescreening of patients treated for genital chlamydial infections?

2002 ◽  
Vol 13 (6) ◽  
pp. 363-367 ◽  
Author(s):  
Per-Anders Mårdh ◽  
Kenneth Persson
Keyword(s):  
False Positive ◽  
Diagnostic Tests ◽  
False Negative ◽  
Partner Notification ◽  
Drug Intake ◽  
Concomitant Therapy ◽  
Present Communication ◽  
Development Of Resistance ◽  
Wrong Dose

The present communication reviews reasons to perform rescreening of chlamydia-infected persons. It brings up difficulties to differentiate between relapse and reinfection. Studies on follow-up of chlamydia-positive cases after therapy are reviewed. It also highlights reasons for therapeutic failure, like compliance, pharmacological factors, including poor bioavailability, wrong dose regimens, lack of adherence to drug intake, neglect of partner notification and concomitant therapy in consorts, possible development of resistance to drugs generally prescribed, false negative or false positive diagnostic tests and reinfection from extra-genital not 'cured' sites. The review points to the need to establish programmes for routine rescreening of chlamydia-infected persons.

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