scholarly journals Evaluation of tests performed to confirm the position of the Veress needle for creation of pneumoperitoneum in selected patients: a prospective clinical trial

2006 ◽  
Vol 21 (6) ◽  
pp. 385-391 ◽  
Author(s):  
Otávio Cansanção de Azevedo ◽  
João Luiz Moreira Coutinho Azevedo ◽  
Albino Augusto Sorbello ◽  
Gustavo Peixoto Soares Miguel ◽  
Jorge Luis Wilson Junior ◽  
...  
Keyword(s):  
Predictive Value ◽  
Iatrogenic Injury ◽  
Veress Needle ◽  
False Negatives ◽  
Injection Test ◽  
Intraperitoneal Pressure ◽  
Left Hypochondrium ◽  
Liquid Injection ◽  
Pressure Test ◽  
Drop Tests

PURPOSE: To evaluate tests performed to confirm the position of the Veress needle inserted into the left hypochondrium for creation of pneumoperitonium. METHODS: One hundred patients were submitted to laparoscopic procedure with left hypochondrium puncturing. Needle positioning tests were evaluated. The aspiration test was considered positive when organic material was aspirated; the injection test was considered positive when no increased resistance to liquid injection was observed; the recovery test was considered positive when the liquid injected was not recovered; the saline drop test was considered positive when drops of saline in the syringe disappeared quickly; the initial intraperitoneal pressure test was considered positive when pressure levels were £ 8 mmHg. A positive aspiration test indicated iatrogenic injury, whereas a positive result in any of the other tests indicated that the tip of the needle was correctly positioned in the peritoneal cavity. Sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of the tests were calculated by correlating results considered true positives (a), false positives (b), false negatives (c) and true negatives (d), according to the formulas: SE = [a/(a + c)] x 100; SP = [d/(b + d)] x 100; PPV = [a/(a + b)] x 100; NPV = [d(c + d)] x 100. RESULTS: With regard to the aspiration test, SE and PPV were not applicable, SP was 100% and NPV was 100%. With regard to the injection test, SE was 0%, SP was 100%, PPV was inexistent and NPV was 90%. Both recovery and saline drop tests yielded the following results: SE was 50%, SP was 100%, PPV was 100% and NPV was 94.7%. The initial intraperitoneal pressure test yielded the following results: SE, SP, PPV and NPV were 100%. CONCLUSIONS: When inserting the Veress needle into the left hypochondrium, a negative aspiration test guarantees the absence of iatrogenic injury; the injection test is not reliable to determine incorrect needle positioning, but it accurately detects correct needle positioning; recovery and saline drop tests are not reliable to determine correct needle positioning, but they accurately detect incorrect needle positioning; the initial intraperitoneal pressure test is reliable to determine both correct and incorrect needle positioning, and proved to be the most reliable of the tests analyzed.

scholarly journals Veress needle insertion in the left hypochondrium in creation of the pneumoperitoneum

2006 ◽  
Vol 21 (5) ◽  
pp. 296-303 ◽  
Author(s):  
Otávio Cansanção de Azevedo ◽  
João Luiz Moreira Coutinho Azevedo ◽  
Albino Augusto Sorbello ◽  
Gustavo Peixoto Soares Miguel ◽  
Rodrigo Santa Cruz Guindalini ◽  
...  
Keyword(s):  
Peritoneal Cavity ◽  
Gas Flow ◽  
Needle Insertion ◽  
Veress Needle ◽  
Flow Volume ◽  
Intraperitoneal Pressure ◽  
Alternative Method ◽  
Left Hypochondrium ◽  
The Creation ◽  
Positive Results

PURPOSE: To test the efficacy of the puncture in the left hypochondrium as an alternative method. METHODS: Sixty-two patients randomly distributed into two groups were studied: Group LH, puncture in the left hypochondrium (n=30), and Group ML, puncture in the abdominal midline (n=32). The following were assessed: needle positioning tests, number of failed attempts at needle insertion, and time needed for creation of pneumoperitoneum. Gas flow, volume and intraperitoneal pressure were recorded at every 20 seconds, until a 12 mmHg pressure was reached inside the peritoneal cavity. RESULTS: A similar number of positive results for the needle positioning tests were observed in both groups. Two failed attempts to reach the peritoneal cavity were observed in Group ML and one in Group LH. The time necessary for the creation of pneumoperitoneum was on average 3 minutes and 46 seconds for Group LH, and 4 minutes and 2 seconds for Group ML. Average gas flow, volume and pressure were equivalent for both groups. CONCLUSION: Puncture in the left hypochondrium was as effective as puncture in the abdominal midline for the creation of pneumoperitoneum.

Test of a Noninvasive Instrument for Measuring Hemoglobin Concentration

1989 ◽  
Vol 5 (4) ◽  
pp. 659-667 ◽  
Author(s):  
Constanza I. Sanchez-Carrillo ◽  
Teresita de Jesus Ramirez-Sanchez ◽  
Marcela Zambrana-Castañeda- ◽  
Beatrice J. Selwyn
Keyword(s):  
Decision Making ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
False Negative ◽  
Hemoglobin Concentration ◽  
Reliability Test ◽  
Intraobserver Variability ◽  
Hemoglobin Content ◽  
False Negatives ◽  
Sensitivity Specificity

A colorimetric instrument for the noninvasive quantification of hemoglobin, designed using color shades resembling those observed in the conjunctiva, was tested. The instrument's colors are contrasted against the color of the conjunctiva to measure hemoglobin content. Sensitivity, specificity, negative predictive value, and false-negative value were estimated to test the instrument's accuracy; kappa coefficients were used to estimate inter- and intraobserver variability. Physician field evaluations of conjunctiva color for the screening of anemia, reported in the literature, have had sensitivities and specificities as high as 70%. Readings with the instrument demonstrated a 63% sensitivity, 72% specificity, and 38% false negatives for screening hemoglobin values of less than or equal to 13 g/dl. The interobserver kappa coefficients for three pairs of readers were good to excellent for the same hemoglobin screening value. Statistically significant differences were noted, however, between observers during the reliability test. The instrument can be used by unskilled personnel to improve their decision-making about whom to send for futher care or for supplementation with iron.

scholarly journals Accuracy of medical billing data against the electronic health record in the measurement of colorectal cancer screening rates

2020 ◽  
Vol 9 (1) ◽  
pp. e000856
Author(s):  
Vivek A Rudrapatna ◽  
Benjamin S Glicksberg ◽  
Patrick Avila ◽  
Emily Harding-Theobald ◽  
Connie Wang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Predictive Value ◽  
Screening Rate ◽  
Billing Data ◽  
False Negatives ◽  
Manual Review ◽  
Medical Billing

ObjectiveMedical billing data are an attractive source of secondary analysis because of their ease of use and potential to answer population-health questions with statistical power. Although these datasets have known susceptibilities to biases, the degree to which they can distort the assessment of quality measures such as colorectal cancer screening rates are not widely appreciated, nor are their causes and possible solutions.MethodsUsing a billing code database derived from our institution’s electronic health records, we estimated the colorectal cancer screening rate of average-risk patients aged 50–74 years seen in primary care or gastroenterology clinic in 2016–2017. 200 records (150 unscreened, 50 screened) were sampled to quantify the accuracy against manual review.ResultsOut of 4611 patients, an analysis of billing data suggested a 61% screening rate, an estimate that matches the estimate by the Centers for Disease Control. Manual review revealed a positive predictive value of 96% (86%–100%), negative predictive value of 21% (15%–29%) and a corrected screening rate of 85% (81%–90%). Most false negatives occurred due to examinations performed outside the scope of the database—both within and outside of our institution—but 21% of false negatives fell within the database’s scope. False positives occurred due to incomplete examinations and inadequate bowel preparation. Reasons for screening failure include ordered but incomplete examinations (48%), lack of or incorrect documentation by primary care (29%) including incorrect screening intervals (13%) and patients declining screening (13%).ConclusionsBilling databases are prone to substantial bias that may go undetected even in the presence of confirmatory external estimates. Caution is recommended when performing population-level inference from these data. We propose several solutions to improve the use of these data for the assessment of healthcare quality.

The Use of Novel Stimuli as Indicators of Aggressive Behavior in Dogs

2004 ◽  
Vol 40 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Tracy L. Kroll ◽  
Katherine A. Houpt ◽  
Hollis N. Erb
Keyword(s):  
Aggressive Behavior ◽  
Predictive Value ◽  
False Positives ◽  
False Negatives ◽  
Aggressive Reaction ◽  
Useful Components ◽  
History Of ◽  
Artificial Hand

To test the predictive value of a doll and an artificial hand, reactions of dogs (n=100) were compared to histories of behavior toward children. Each dog’s reaction to the doll and the hand was categorized as normal, fearful, fearfully aggressive, or offensively aggressive. Sixty-five percent (n=37) of the dogs that had a normal or no reaction to the stimuli had a history of being good with children. Eighty-eight percent (n=34) of the dogs that had an aggressive reaction to the doll had a history of aggressive behavior toward a child. Dogs that were fearfully aggressive were significantly more likely to show fearful responses to the doll, and dogs that were either dominant or fearfully aggressive were more likely to exhibit aggression of the same type to the hand. The results of this study indicate that the doll and, to a lesser extent, the hand may be useful components in determining the aggressive tendencies of dogs. The results also point out the major limitations, because the false positives and false negatives are too frequent.

Evaluation of Indocyanine Green Fluorescence Imaging for Intraoperative Identification of Liver Malignancy

2021 ◽  
Vol 39 ◽  
Author(s):  
Jorge Rodriguez ◽  
◽  
Jan Grendar ◽  
Zeljka Jutric ◽  
Maria Cassera ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Predictive Value ◽  
False Positives ◽  
False Negatives ◽  
Imaging Evaluation ◽  
Liver Malignancy ◽  
Indocyanine Green Fluorescence ◽  
Indocyanine Green Fluorescence Imaging ◽  
Hepatic Lesions

Introduction: There is early evidence that indocyanine green (ICG) fluorescence imaging has the ability to detect metastatic and primary malignancies in the liver that are too small to be identified by other methods. However, the rate of false positives and false negatives remains unknown. Materials and Methods: This is a single institution prospective single-arm study. Patients with suspected hepatic or pancreatic malignancies were intravenously injected with ICG one to three days prior to their scheduled surgical therapy. At the beginning of the procedure, the liver was assessed with fluorescence imaging and all identified lesions were biopsied and evaluated. Results: Twenty-three patients were enrolled from April 2015 through February 2016. Fifteen patients with confirmed malignancy had adequate fluorescence imaging evaluation of the liver; 10 with pancreatic primary malignancies and five with hepatic primaries. Fluorescence imaging was the only modality that identified nine concerning hepatic lesions, all of which were benign on pathology examination. Out of 11 malignant hepatic masses, six were visible on fluorescence imaging. Out of nine benign hepatic lesions, five were visible. No side effects or complications of the fluorescence imaging were encountered. The sensitivity for ICG fluorescence was 45.5%, the specificity 21.2%, the positive predictive value 25%, and the negative predictive value 40%. Conclusion: Intraoperative hepatic assessment with ICG fluorescence imaging to identify malignancy in the liver is feasible and safe. However, in this study the significant number of false positives limit the utility of the technique. Our preliminary data do not support its routine use for detection of malignancies in the liver.

Prehospital Use of a Prototype Esophageal Detection Device: A Word of Caution!

1996 ◽  
Vol 11 (3) ◽  
pp. 223-227 ◽  
Author(s):  
Charles D. Marley ◽  
David R. Eitel ◽  
Mark F. Koch ◽  
Dean R. Hess ◽  
Michael A. Taigman
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
False Positives ◽  
Data Sheet ◽  
Prehospital Setting ◽  
Correct Identification ◽  
False Negatives ◽  
Convenience Sample ◽  
Endotracheal Tubes

AbstractObjective:To determine the effectiveness of a prototype esophageal detection device (EDD) during use in the prehospital setting.Design/Setting:Prospective convenience sample in a prehospital setting.Population:Intubated adult patients.Interventions:The study device was used to determine esophageal or endotracheal placement of endotracheal tubes in intubated patients. Clinical means were used to confirm tube location. A data sheet was completed for each patient.Results:Of 105 uses of the device, 17 of 17 esophageal tubes were identified correctly (100% sensitivity). Sixty-five of 88 tracheal tubes were correctly identified (78% specificity). There was intermediate reinflation of the device on 13 of the 65 tracheal tubes. Five tests were indeterminate. There were no false negatives (negative predictive value 100%), but 18 false positives (positive predictive value 48%).Conclusion:This prototype EDD adequately identifies esophageally placed endotracheal tubes. Correct identification of endotracheally placed tubes was less sensitive. Much work needs to be done regarding the use of negative aspiration devices to identify placement of endotracheal tubes.

Intraperitoneal Pressure and Volume of Gas Injected as Effective Parameters of the Correct Position of the Veress Needle During Creation of Pneumoperitoneum

2009 ◽  
Vol 19 (6) ◽  
pp. 731-734 ◽  
Author(s):  
João L.M.C. Azevedo ◽  
Otavio C. Azevedo ◽  
Albino A. Sorbello ◽  
Otavio M. Becker ◽  
Otavio Hypolito ◽  
...  
Keyword(s):  
Veress Needle ◽  
Effective Parameters ◽  
Correct Position ◽  
Intraperitoneal Pressure

scholarly journals Comparison Effect of Direct Trocar and Veress Needle Entry Techniques on Gut Functions after Laparoscopic Procedures: Randomized Clinical Trial

2016 ◽  
Author(s):  
Taylan Şenol ◽  
Mesut Polat ◽  
Enis Özkaya ◽  
İlhan Şanverdi ◽  
Birsen Konukçu ◽  
...  
Keyword(s):  
Laparoscopic Approach ◽  
The Body ◽  
Veress Needle ◽  
Intraabdominal Pressure ◽  
Intraperitoneal Pressure ◽  
Laparoscopic Entry ◽  
Significant Difference ◽  
Group 2 ◽  
Needle Entry ◽  
Index Comparison

<p><strong>OBJECTIVE:</strong> The aim of this study was to compare the effect of two different laparoscopic entry methods on postoperative gastrointestinal functions.<br /><strong>STUDY DESIGN:</strong> A total of 108 women who underwent gynecological operation via laparoscopic approach with different indications were randomly assigned to 2 groups: In Group 1 pneumoperiteneum was achieved by direct trocar entry (n=72), while in group 2, Veress needle was used.<br /><strong>RESULTS:</strong> Correlation analyses showed a significant association between the technique for abdominal entry and postoperative hemoglobin and hematocrit concentrations, time to maximal intraabdominal pressure and the body mass index. Comparison of groups with different laparoscopic entry techniques showed a significant difference between groups in terms of postoperative hemoglobin and hematocrit concentrations, time to obtain maximal intraabdominal pressure and time to first flatulence (p &lt; 0.05, Table 2). No intra or postoperative complications was observed.<br /><strong>CONCLUSION:</strong> Direct or Veress needle entry methods were both safe to create pneumoperitoneum with similar postoperative gastrointestinal functions except for earlier first flatulence in Veress needle group while direct trocar entry was found to be associated with favorable postoperative blood count and shorter duration to obtain enough intraperitoneal pressure.</p>

scholarly journals The predictive value of the sacral base pressure test in detecting specific types of sacroiliac dysfunction

2007 ◽  
Vol 6 (2) ◽  
pp. 45-55 ◽  
Author(s):  
Travis D. Mitchell ◽  
Kristina E. Urli ◽  
Jacques Breitenbach ◽  
Chris Yelverton
Keyword(s):  
Predictive Value ◽  
Base Pressure ◽  
Pressure Test

Fine-Needle Aspiration Cytodiagnosis of the « Cold » Thyroid Nodule

1989 ◽  
Vol 75 (5) ◽  
pp. 475-477 ◽  
Author(s):  
Michele Giansanti ◽  
Silvio Monico ◽  
Paolo Fugiani
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Thyroid Neoplasms ◽  
Needle Aspiration ◽  
False Negatives ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Test Efficiency ◽  
Needle Aspiration Cytology

The results of 1886 fine-needle cytoaspirations of solid, palpable thyroid nodules, « cold » on scintiscanning, performed between 1 January 1978 and 31 December 1986, were analyzed. In total 36 diagnoses of malignancy were made (1.9%). The results of cytologic and histologic examinations were compared in 114 cases to verify the diagnostic accuracy of this method; there was agreement in 98 cases and discordance in 16 consisting of 13 false negatives (11.4%) and 3 false positives (2.6 %). The sensitivity was 77.9 %, specificity 94.5 %, positive predictive value 93.8 %, negative predictive value 80 % and test efficiency 86 %. These values are in the range of those reported in the literature and confirm the validity of fine-needle aspiration cytology in the preoperative diagnosis of thyroid neoplasms.

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