HLA-B27 as a diagnostic screening tool in chronic low back pain

Forty-five of 52 consecutive patients with chronic low back pain were screened for presence of HLA-B27 antigen one year after they were included in a rehabilitative program. Six (13.3%) were positive and, when re-examined radiographically, 2 had signs of ankylosing spondylitis. The proportion of antigen-positive individuals is similar to that found in a population study of healthy Swedish blood donors, and within the range of other populations of healthy controls. It is concluded that HLA-B27 is of limited diagnostic value as a screening test for ankylosing spondylitis in a patient group with chronic low back pain.     

An alternative way to think about glaucoma screening, using a questionnaire as a tool, Chinese version

Rationale, aims and objectives To develop a short screening test for the detection of preclinical glaucoma. Method This case–control study involved 690 participants aged 40 years or older: 338 patients with glaucoma or suspected glaucoma and 352 patients without glaucoma, who served as a control group. All participants were interviewed by a single trained research assistant. Patients' basic demographic and clinical information, past ophthalmic history and responses on the National Eye Institute 25‐item Visual Function Questionnaire were collected. Two glaucoma‐trained ophthalmologists examined all the participants using standard procedures to make a diagnosis. The biostatistical differences between the two groups were determined. Results Five items were selected for glaucoma screening: ‘Sense of worse vision compared with those of the same age’, ‘Ocular pain or discomfort during the past 6 months’, ‘History of cataract’, ‘Family history of glaucoma’ and ‘Hyperopia’. A score of 2 or more was used to define a group of positive cases with the most appropriate values for sensitivity (79.0%), specificity (76.7%) and predictive power (a positive predictive value of 76.5% and a negative predictive value of 79.2%). Conclusion A five‐item instrument was developed to detect preclinical glaucoma. Anyone with a score of 2 or more may need further ophthalmic examination and treatment.     

TCOMs as a screening tool for hyperbaric oxygen therapy.

Transcutaneous oximetry (TcPO2), often referred to as TCOM, is a noninvasive measurement of oxygen tension in the tissue via a heated electrode. TCOMs can be used prior to beginning hyperbaric oxygen (HBO) treatment to determine if the patient has adequate blood flow to the wounded area to benefit from HBO. A case study of how it can be used in a problematic wound is presented.     

Assessment of the SpO2/FiO2 ratio as a tool for hypoxemia screening in the emergency department

ObjectiveWe assessed the performance of the ratio of peripheral arterial oxygen saturation to the inspired fraction of oxygen (SpO₂/FiO₂) to predict the ratio of partial pressure arterial oxygen to the fraction of inspired oxygen (PaO₂/FiO₂) among patients admitted to our emergency department (ED) during the SARS-CoV-2 outbreak.MethodsWe retrospectively studied patients admitted to an academic-level ED in France who were undergoing a joint measurement of SpO₂ and arterial blood gas. We compared SpO₂ with SaO₂ and evaluated performance of the SpO₂/FiO₂ ratio for the prediction of 300 and 400 mmHg PaO₂/FiO₂ cut-off values in COVID-19 positive and negative subgroups using receiver-operating characteristic (ROC) curves.ResultsDuring the study period from February to April 2020, a total of 430 arterial samples were analyzed and collected from 395 patients. The area under the ROC curves of the SpO₂/FiO₂ ratio was 0.918 (CI 95% 0.885–0.950) and 0.901 (CI 95% 0.872–0.930) for PaO₂/FiO₂ thresholds of 300 and 400 mmHg, respectively. The positive predictive value (PPV) of an SpO₂/FiO₂ threshold of 350 for PaO₂/FiO₂ inferior to 300 mmHg was 0.88 (CI95% 0.84–0.91), whereas the negative predictive value (NPV) of the SpO₂/FiO₂ threshold of 470 for PaO₂/FiO₂ inferior to 400 mmHg was 0.89 (CI95% 0.75–0.96). No significant differences were found between the subgroups.ConclusionsThe SpO₂/FiO₂ ratio may be a reliable tool for hypoxemia screening among patients admitted to the ED, particularly during the SARS-CoV-2 outbreak.     

Assessment of the reliability of pediatric screening: a tool for occupational or physical therapists

This study was conducted to determine interrater and test-retest reliability characteristics of the instrument, Pediatric Screening: A Tool for Occupational and Physical Therapists. This protocol was developed by two public school therapists to be used as a decision-making mechanism for systematically assessing the students' relative need for therapy services. The subjects were 75 children, aged 3 to 16 years, with various types and degrees of disability. Each was scored on the screening tool by three different school therapists within one week to determine interrater reliability. Each of the therapists also tested two or three of the children again several weeks later to determine test-retest reliability. Analysis of interrater reliability using the Spearman-Brown prediction formula showed total scores on the screening tool to be reliable at the .90 level. Test-retest reliability measurements using the Pearson product-moment correlation coefficients showed that total scores were highly correlated (r = .96; p less than .001). These measures indicated that the Pediatric Screening tool is a highly reliable instrument in terms of scoring between therapists and by individual therapists across time.     

Ultrasonic measurement of lumbar canal diameter: a screening tool for low back disorders?

Preventive screening measures for low back pain are limited. Despite considerable evidence that anatomic narrowing of the lumbar spinal canal is a risk factor for specific back problems, difficulty in measuring the canal without unacceptable radiation exposure, cost, or discomfort has limited the assessment of its clinical significance. Using ultrasound to measure the lumbar canal is relatively easy to do, and provides accurate values. In this paper we review the reports on this use of ultrasound, including our own experience in a case control study, and discuss the potential use of ultrasonic measurement as a screening tool to identify narrow lumbar canals.     

Reliability of repetitive dynamic strengths as a screening tool for manual lifting tasks

Recent studies have shown that maximal dynamic strengths (MDSs) of individuals are superior and more reliable predictors of their maximum safe lifting capacity compared to maximal static strengths. The evidence, however, is based on studies that have investigated only infrequent lifting activities, i.e. lifting only a few times a day and with complete recovery from fatigue between successive lifts. It remains to be seen if MDSs are also as highly correlated to lifting capacity for frequent lifting tasks i.e. tasks that do not allow complete recovery from fatigue between successive lifts.The study reported here was conducted to determine the degree of affinity between MDSs and lifting capacities of individuals for frequent and infrequent lifting tasks. In addition, the hypothesis that lifting capacity for frequent manual lifting tasks will be more highly correlated to dynamic strength values which take into account the effect of repetition related fatigue, instead of MDSs, was tested.The results overwhelmingly supported the hypothesis. We therefore concluded that repetitive dynamic strength (RDS) is a more accurate measure of an individual's lifting capacity for frequently performed tasks, than maximal static or dynamic strengths, and deserves recognition as a reliable pre-employment screening tool for frequently performed manual lifting tasks. The experimental evidence also indicated that manual lifting tasks performed once every minute or less frequently are strength oriented while those per formed three times a minute or more frequently are not.     

痴呆测查的新方法:电话问卷

目的评价老年人认知功能下降知情者问卷(informantquestionnaireoncognitivedeclineintheelderly,IQCODE)、面访和电话访问测查痴呆的信度和效度。方法按照DSM-IV痴呆标准诊断的65例痴呆组患者和67例健康社区老年对照组进行了测查,采用盲法对相关的知情者应用IQCODE的26项版本及16项版本进行了访查。结果IQCODE面访和电话访问评分的相关系数为0.91。以3.40/3.43为分界值,IQCODE面访的敏感性和特异性分别为89.8%和82.5%;电话访问的敏感性和特异性分别为88.9%和83.6%。16项简短版本的敏感性和特异性分别为86.1%和81.9%。结论IQCODE是简洁、可靠、有效的痴呆测查工具,面访和电话访问都具有良好的信度、效度和一致性。它与MMSE结合使用,提高了检测的敏感性和特异性。     

The importance of the STOP- BANG questionnaire as a preoperative assessment tool for the elderly population

Undiagnosed obstructive sleep apnea (OSA) may adversely impact surgical patients and can lead to increased morbidity and mortality during the perioperative period, especially among the geriatric patient population (Chung et al. 2008, 2012, 2014; McDonald et al., 2018; Zietlow et al., 2018; Singh et al., 2012). The setting of this quality improvement project was a preoperative anesthesia and geriatric evaluation clinic housed within a 957-bed tertiary academic affiliated hospital. The sample included 45 patients who met the criteria established for surgery and OSA screening preoperatively. Nine patients (20.0%) were assessed as low risk (Stop-bang [SB] score </=2) for OSA, and 36 patients (80.0%) had a prior diagnosis from an ICD-9/10 code or a SB score >/= 3 indicative of high-risk for OSA. The retrospective utilization of a modified SB screening on charts that did not receive a clinical OSA evaluation (n = 52) detected 23 (44.2%) patients who were considered high-risk for OSA but were not identified prior to surgery. The SB questionnaire is underutilized, and patients’ OSA is often unidentified prior to surgery.     

Development of miniaturized competitive immunoassays on a protein chip as a screening tool for drugs

BACKGROUND: Doping in sports has become a serious problem. Gas chromatography-mass spectrometry (GC-MS) serves as an effective reference method, but it is limited by low throughput and is therefore not suitable for large-scale screening. Use of protein chips for high-throughput screening of all athletes for prohibited substances could become an important complementary tool to GC-MS. METHODS: We developed a protein chip based on an aldehyde-activated glass slide containing 10 physically isolated arrays. The chip was used to screen urine from 1347 athletes for prohibited substances and to screen a negative control group consisting of 200 females and 120 males. Urine samples from 66 individuals known to be abusers, provided by the China Doping Control Center (CDCC), and 129 standard prohibited substances were tested as positive controls. RESULTS: All 1347 urine samples screened by means of the protein chips were also subjected to reference analysis by GC-MS at the CDCC. There was no qualitative difference between the results obtained with the two methods. The correlation coefficient (r(2)) for the quantitative results obtained with the protein chip and GC-MS was 0.991. CONCLUSIONS: The protein chip could be used to screen for a series of 16 prohibited drugs in urine samples. This system has the potential to become an effective screening method to test substances prohibited by the International Olympic Committee.     

Recombinant green fluorescent protein-expressing human cytomegalovirus as a tool for screening antiviral agents

A recombinant human cytomegalovirus (AD169-GFP) expressing green fluorescent protein was generated by homologous recombination. Infection of human fibroblast cultures with AD169-GFP virus produced stable and readily detectable amounts of GFP signals which were quantitated by automated fluorometry. Hereby, high levels of sensitivity and reproducibility could be achieved, compared to those with the conventional plaque reduction assay. Antiviral activities were determined for four reference compounds as well as a set of putative novel cytomegalovirus inhibitors. The results obtained were exactly in line with the known characteristics of reference compounds and furthermore revealed distinct antiviral activities of novel in vitro inhibitors. The fluorometric data could be confirmed by GFP-based flow cytometry and fluorescence microscopy. In addition, laboratory virus variants derived from the recombinant AD169-GFP virus provided further possibilities for study of the characteristics of drug resistance. The GFP-based antiviral assay appeared to be very reliable for measuring virus-inhibitory effects in concentration- and time-dependent fashions and might also be adaptable for high-throughput screenings of cytomegalovirus-specific antiviral agents.     

Diffusion-weighted MRI as a screening tool of stroke in the ED

This report describes a novel imaging technology for the evaluation of stroke patients. Diffusion-weighted magnetic resonance imaging can visualize hyperacute ischemic stroke which cannot be seen on computed tomography; moreover, it only takes few minutes to scan. We believe that diffusion-weighted magnetic resonance imaging, rather than routine computed tomography, should be considered when the emergency physician evaluates a patient with acute ischemic stroke.     

The smiley as a simple screening tool for depression after stroke: a preliminary study

In Hong Kong, there is a paucity of evidence to support which tool is superior in measuring depression after stroke (DAS). A simple, non-language-based, culturally neutral, non-verbal and easy to apply tool that is not highly dependent on training will be desirable. OBJECTIVES: The present study aimed to examine the clinical utility of three smiley pictures in detecting DAS for older Chinese patients at 1 month after first-ever ischemic stroke. METHODS: This was a cross-sectional study. A total of 253 stroke patients were interviewed by a research nurse at 1-month follow-up. RESULTS: Taking Diagnostic and Statistic Manual (DSM IV) as the gold standard, the measurement properties of emoticon (sad) in terms of sensitivity, specificity, positive and negative predictive values, as well as Kappa's value were found comparable to Geriatric Depression Scale (GDS). The emoticon (happy) demonstrated a highly significant inverse relationship with all depression assessment tools (p<0.001). It was also found that the emoticon (flat) could capture 98% of all depressed subjects identified by DSM IV, although its predictive values were less satisfactory. CONCLUSIONS: The smiley pictures seemed to fulfil the requirements for early and prompt screening among older patients. Cultural implication regarding emotions dissipation among Chinese patients should be further studied.