Patient anxiety and experiences associated with an outpatient "one-stop" "see and treat" hysteroscopy clinic

BACKGROUND: "One-stop" outpatient hysteroscopy clinics have become well established for the investigation and treatment of women with abnormal uterine bleeding. However, the advantages of these clinics may be offset by patient factors such as anxiety, pain, and dissatisfaction. This study aimed to establish patients' views and experiences of outpatient service delivery in the context of a one-stop diagnostic and therapeutic hysteroscopy clinic, to determine the amount of anxiety experienced by these women and compare this with other settings, and to determine any predictors for patient preferences. METHODS: The 20-item State-Trait Anxiety Inventory was given to 240 women attending a one-stop hysteroscopy clinic: to 73 consecutive women before their appointment in a general gynecology clinic and to 36 consecutive women attending a chronic pelvic pain clinic. The results were compared with published data for the normal female population, for women awaiting major surgery, and for women awaiting a colposcopy clinic appointment. In addition, a questionnaire designed to ascertain patients' views and experiences was used. Logistic regression analysis was used to delineate the predictive values of diagnostic or therapeutic hysteroscopy, and to determine their effect on the preference of patients to have the procedure performed under general anesthesia in the future. RESULTS: Women attending the hysteroscopy clinic in this study reported significantly higher levels of anxiety than those attending the general gynecology clinic (median, 45 vs 39; p = 0.004), but the levels of anxiety were comparable with those of women attending the chronic pelvic pain clinic (median, 45 vs 46; p = 0.8). As compared with the data from the normal female population (mean, 35.7) and those reported for women awaiting major surgery (mean, 41.2), the levels of anxiety experienced before outpatient hysteroscopy clinic treatment were found to be higher (mean, 45.7). Only women awaiting colposcopy (6-item mean score, 51.1 +/- 13.3) experienced significantly higher anxiety scores than the women awaiting outpatient hysteroscopy (6-item mean score, 47.3 +/- 13.9; p = 0.002). Despite their anxiety, most women are satisfied with the outpatient hysteroscopy "see and treat" service. High levels of anxiety, particularly concerning pain but not operative intervention, were significant predictors of patients desiring a future procedure to be performed under general anesthesia. CONCLUSIONS: Outpatient hysteroscopy is associated with significant anxiety, which increases the likelihood of intolerance for the outpatient procedure. However, among those undergoing operative therapeutic procedures, dissatisfaction was not associated with the outpatient setting.

Optimising the diagnostic performance of the Geriatric Depression Scale

The aim of this work is to empirically generate a shortened version of the Geriatric Depression Scale (GDS), with the intention of maximising the diagnostic performance in the detection of depression compared with previously GDS validated versions, while optimizing the size of the instrument. A total of 233 individuals (128 from a Day Hospital, 105 randomly selected from the community) aged 60 or over completed the GDS and other measures. The 30 GDS items were entered in the Day Hospital sample as independent variables in a stepwise logistic regression analysis predicting diagnosis of Major Depression. A final solution of 10 items was retained, which correctly classified 97.4% of cases. The diagnostic performance of these 10 GDS items was analysed in the random sample with a receiver operating characteristic (ROC) curve. Sensitivity (100%), specificity (97.2%), positive (81.8%) and negative (100%) predictive power, and the area under the curve (0.994) were comparable with values for GDS-30 and higher compared with GDS-15, GDS-10 and GDS-5. In addition, the new scale proposed had excellent fit when testing its unidimensionality with CFA for categorical outcomes (e.g., CFI=0.99). The 10-item version of the GDS proposed here, the GDS-R, seems to retain the diagnostic performance for detecting depression in older adults of the GDS-30 items, while increasing the sensitivity and predictive values relative to other shortened versions.

Epidemiologic Features of Vulvovaginal Candidiasis among Reproductive-Age Women in India

Background. Vulvovaginal candidiasis is characterized by curd-like vaginal discharge and itching, and is associated with considerable health and economic costs. Materials and Methods. We examined the incidence, prevalence, and risk factors for vulvovaginal candidiasis among a cohort of 898 women in south India. Participants completed three study visits over six months, comprised of a structured interview and a pelvic examination. Results. The positive predictive values for diagnosis of vulvovaginal candidiasis using individual signs or symptoms were low (<19%). We did not find strong evidence for associations between sociodemographic characteristics and the prevalence of vulvovaginal candidiasis. Women clinically diagnosed with bacterial vaginosis had a higher prevalence of vulvovaginal candidiasis (Prevalence 12%, 95% CI 8.2, 15.8) compared to women assessed to be negative for bacterial vaginosis (Prevalence 6.5%, 95% 5.3, 7.6); however, differences in the prevalence of vulvovaginal candidiasis were not observed by the presence or absence of laboratory-confirmed bacterial vaginosis. Conclusions. For correct diagnosis of vulvovaginal candidiasis, laboratory confirmation of infection with Candida is necessary as well as assessment of whether the discharge has been caused by bacterial vaginosis. Studies are needed of women infected with Candida yeast species to determine the risk factors for yeast’s overgrowth.

Acurácia dos indicadores clínicos do diagnóstico de enfermagem falta de adesão em pessoas vivendo com AIDS

In the early 1990s, a major milestone in the treatment of Acquired Immune Deficiency Syndrome was the development of highly active combination antiretroviral therapy. The great benefit generated by the use of this therapy was prolonging the survival of the people who got this disease, since it is no longer considered fatal, becoming a chronic condition. Despite improvements generated by this therapy, there are still many difficulties to be overcome. One is the patient adherence to their treatment, bringing challenges to services and health professionals. Hence the need for early identification of nursing diagnosis Lack of Accession so that solutions are sought by the nurse with the patient and his family. With this problem, adds to the difficulty of hospital nurses in inferring that diagnosis, especially in identifying their defining characteristics. In this context, the objective was to evaluate the accuracy of clinical indicators of nursing diagnosis Lack of Adherence to antiretroviral treatment for people living with the Acquired Immunodeficiency Syndrome. The research took place in two stages. The first consists of the evaluation of the diagnostic indicators in the study; and second, the diagnostic inference performed by specialist nurses. The first step took place in a referral hospital in the treatment of infectious diseases in the Northeast of Brazil, and data were collected through an instrument for carrying out history and physical examination and analyzed for the presence or absence of the diagnostic indicators. In the second stage, the data were sent to experts, who judged the presence or absence of the diagnosis in the studied clientele. The project was submitted to the Ethics Committee of the Federal University of Rio Grande do Norte, obtaining approval with the General Certificate for Ethics Assessment (CAAE) No 46206215.3.0000.5537. Data were analyzed using descriptive and inferential statistics. Test were used Fisher's exact, chi-square test of Pearson and logistic regression. Since the accuracy of clinical indicators was measured by sensitivity, specificity, predictive values, likelihood ratios. As a result, we identified the presence of diagnosis Lack of Accession on 69% (n = 78) of the study patients. The defining characteristics that showed statistically significant association with the diagnosis studied were: lack of adherence behavior, complications related to development, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. The characteristic with greater sensitivity was missing scheduled appointments and the highest specificity behavior of noncompliance. The logistic regression showed as predictors for the diagnosis Lack of Accession: lack of adherence behavior, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. It was concluded that the identification of clinical indicators accurately enabled a good prediction of the nursing diagnosis Lack of Accession on people living with the Acquired Immune Deficiency Syndrome, helping nurses develop early on strategies for promoting adherence to the use of antiretrovirals.

Acurácia dos indicadores clínicos do diagnóstico de enfermagem falta de adesão em pessoas vivendo com AIDS

In the early 1990s, a major milestone in the treatment of Acquired Immune Deficiency Syndrome was the development of highly active combination antiretroviral therapy. The great benefit generated by the use of this therapy was prolonging the survival of the people who got this disease, since it is no longer considered fatal, becoming a chronic condition. Despite improvements generated by this therapy, there are still many difficulties to be overcome. One is the patient adherence to their treatment, bringing challenges to services and health professionals. Hence the need for early identification of nursing diagnosis Lack of Accession so that solutions are sought by the nurse with the patient and his family. With this problem, adds to the difficulty of hospital nurses in inferring that diagnosis, especially in identifying their defining characteristics. In this context, the objective was to evaluate the accuracy of clinical indicators of nursing diagnosis Lack of Adherence to antiretroviral treatment for people living with the Acquired Immunodeficiency Syndrome. The research took place in two stages. The first consists of the evaluation of the diagnostic indicators in the study; and second, the diagnostic inference performed by specialist nurses. The first step took place in a referral hospital in the treatment of infectious diseases in the Northeast of Brazil, and data were collected through an instrument for carrying out history and physical examination and analyzed for the presence or absence of the diagnostic indicators. In the second stage, the data were sent to experts, who judged the presence or absence of the diagnosis in the studied clientele. The project was submitted to the Ethics Committee of the Federal University of Rio Grande do Norte, obtaining approval with the General Certificate for Ethics Assessment (CAAE) No 46206215.3.0000.5537. Data were analyzed using descriptive and inferential statistics. Test were used Fisher's exact, chi-square test of Pearson and logistic regression. Since the accuracy of clinical indicators was measured by sensitivity, specificity, predictive values, likelihood ratios. As a result, we identified the presence of diagnosis Lack of Accession on 69% (n = 78) of the study patients. The defining characteristics that showed statistically significant association with the diagnosis studied were: lack of adherence behavior, complications related to development, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. The characteristic with greater sensitivity was missing scheduled appointments and the highest specificity behavior of noncompliance. The logistic regression showed as predictors for the diagnosis Lack of Accession: lack of adherence behavior, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. It was concluded that the identification of clinical indicators accurately enabled a good prediction of the nursing diagnosis Lack of Accession on people living with the Acquired Immune Deficiency Syndrome, helping nurses develop early on strategies for promoting adherence to the use of antiretrovirals.

A randomized trial comparing the diagnostic accuracy of visual inspection with acetic acid to Visual Inspection with Lugol's Iodine for cervical cancer screening in HIV-infected women.

Visual inspection with Acetic Acid (VIA) and Visual Inspection with Lugol’s Iodine (VILI) are increasingly recommended in various cervical cancer screening protocols in low-resource settings. Although VIA is more widely used, VILI has been advocated as an easier and more specific screening test. VILI has not been well-validated as a stand-alone screening test, compared to VIA or validated for use in HIV-infected women. We carried out a randomized clinical trial to compare the diagnostic accuracy of VIA and VILI among HIV-infected women. Women attending the Family AIDS Care and Education Services (FACES) clinic in western Kenya were enrolled and randomized to undergo either VIA or VILI with colposcopy. Lesions suspicious for cervical intraepithelial neoplasia 2 or greater (CIN2+) were biopsied. Between October 2011 and June 2012, 654 were randomized to undergo VIA or VILI. The test positivity rates were 26.2% for VIA and 30.6% for VILI (p = 0.22). The rate of detection of CIN2+ was 7.7% in the VIA arm and 11.5% in the VILI arm (p = 0.10). There was no significant difference in the diagnostic performance of VIA and VILI for the detection of CIN2+. Sensitivity and specificity were 84.0% and 78.6%, respectively, for VIA and 84.2% and 76.4% for VILI. The positive and negative predictive values were 24.7% and 98.3% for VIA, and 31.7% and 97.4% for VILI. Among women with CD4+ count < 350, VILI had a significantly decreased specificity (66.2%) compared to VIA in the same group (83.9%, p = 0.02) and compared to VILI performed among women with CD4+ count ≥ 350 (79.7%, p = 0.02). VIA and VILI had similar diagnostic accuracy and rates of CIN2+ detection among HIV-infected women.

Common polygenic variation enhances risk prediction for Alzheimer's disease.

The identification of subjects at high risk for Alzheimer’s disease is important for prognosis and early intervention. We investigated the polygenic architecture of Alzheimer’s disease and the accuracy of Alzheimer’s disease prediction models, including and excluding the polygenic component in the model. This study used genotype data from the powerful dataset comprising 17 008 cases and 37 154 controls obtained from the International Genomics of Alzheimer’s Project (IGAP). Polygenic score analysis tested whether the alleles identified to associate with disease in one sample set were significantly enriched in the cases relative to the controls in an independent sample. The disease prediction accuracy was investigated in a subset of the IGAP data, a sample of 3049 cases and 1554 controls (for whom APOE genotype data were available) by means of sensitivity, specificity, area under the receiver operating characteristic curve (AUC) and positive and negative predictive values. We observed significant evidence for a polygenic component enriched in Alzheimer’s disease (P = 4.9 × 10−26). This enrichment remained significant after APOE and other genome-wide associated regions were excluded (P = 3.4 × 10−19). The best prediction accuracy AUC = 78.2% (95% confidence interval 77–80%) was achieved by a logistic regression model with APOE, the polygenic score, sex and age as predictors. In conclusion, Alzheimer’s disease has a significant polygenic component, which has predictive utility for Alzheimer’s disease risk and could be a valuable research tool complementing experimental designs, including preventative clinical trials, stem cell selection and high/low risk clinical studies. In modelling a range of sample disease prevalences, we found that polygenic scores almost doubles case prediction from chance with increased prediction at polygenic extremes.

Intravoxel Incoherent Motion Metrics as Potential Biomarkers for Survival in Glioblastoma.

OBJECTIVE: Intravoxel incoherent motion (IVIM) is an MRI technique with potential applications in measuring brain tumor perfusion, but its clinical impact remains to be determined. We assessed the usefulness of IVIM-metrics in predicting survival in newly diagnosed glioblastoma. METHODS: Fifteen patients with glioblastoma underwent MRI including spin-echo echo-planar DWI using 13 b-values ranging from 0 to 1000 s/mm2. Parametric maps for diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) were generated for contrast-enhancing regions (CER) and non-enhancing regions (NCER). Regions of interest were manually drawn in regions of maximum f and on the corresponding dynamic susceptibility contrast images. Prognostic factors were evaluated by Kaplan-Meier survival and Cox proportional hazards analyses. RESULTS: We found that fCER and D*CER correlated with rCBFCER. The best cutoffs for 6-month survival were fCER>9.86% and D*CER>21.712 x10-3mm2/s (100% sensitivity, 71.4% specificity, 100% and 80% positive predictive values, and 80% and 100% negative predictive values; AUC:0.893 and 0.857, respectively). Treatment yielded the highest hazard ratio (5.484; 95% CI: 1.162-25.88; AUC: 0.723; P = 0.031); fCER combined with treatment predicted survival with 100% accuracy. CONCLUSIONS: The IVIM-metrics fCER and D*CER are promising biomarkers of 6-month survival in newly diagnosed glioblastoma.

Montreal Cognitive Assessment (MoCA): validation study for vascular dementia

The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment, having surpassed the well-known limitations of the MMSE. The aim of the present study was to validate the MoCA as well as its short version, which was proposed by the NINDS-CSN VCI Harmonization Standards for screening Vascular Dementia (VaD) patients. The results, based on a homogeneous sample of 34 VaD patients, indicate that the MoCA is a psychometrically valid and reliable instrument for cognitive screening in VaD patients, showing excellent discriminant validity. Both the full and short versions of the MoCA had excellent diagnostic accuracy in discriminating VaD patients, exhibiting an area under curve (AUC) higher than the MMSE [AUC(MoCA full version) = .950; 95% IC = .868-.988; AUC(MoCA short version) = .936; 95% IC = .849-.981; AUC(MMSE) = .860; 95% IC = .754-.932]. With a cutoff below 17 on the MoCA full version and 8 on the short version, the results for sensitivity, specificity, positive and negative predictive values, and classification accuracy were superior compared to the MMSE. In conclusion, both versions of the MoCA are valid, reliable, sensitive and accurate screening instruments for VaD patients.

Evaluación del desempeño de pruebas diagnósticas de tuberculosis en pacientes VIH positivo en dos hospitales públicos de Bogotá

La tuberculosis TB es una de las principales causas de muerte en el mundo en individuos con infección por VIH. En Colombia esta coinfección soporta una carga importante en la población general convirtiéndose en un problema de salud pública. En estos pacientes las pruebas diagnósticas tienen sensibilidad inferior y la enfermedad evoluciona con mayor frecuencia hacia formas diseminadas y rápidamente progresivas y su diagnóstico oportuno representa un reto en Salud. El objetivo de este proyecto es evaluar el desempeño de las pruebas diagnósticas convencionales y moleculares, para la detección de TB latente y activa pacientes con VIH, en dos hospitales públicos de Bogotá. Para TB latente se evaluó la concordancia entre las pruebas QuantiFERON-TB (QTF) y Tuberculina (PPD), sugiriendo superioridad del QTF sobre la PPD. Se evaluaron tres pruebas diagnósticas por su sensibilidad y especificidad, baciloscopia (BK), GenoType®MTBDR plus (Genotype) y PCR IS6110 teniendo como estándar de oro el cultivo. Los resultados de sensibilidad (S) y especificidad (E) de cada prueba con una prevalencia del 19,4 % de TB pulmonar y extrapulmonar en los pacientes que participaron del estudio fue: BK S: 64% E: 99,1%; Genotype S: 77,8% E: 94,5%; PCRIS6110 S: 73% E: 95,5%, de la misma forma se determinaron los valores predictivos positivos y negativos (VPP y VPN) BK: 88,9% y 94,8%, Genotype S: 77,8% E: 94,5%; PCRIS6110 S: 90% y 95,7%. Se concluyó bajo análisis de curva ROC que las pruebas muestran un rendimiento diagnóstico similar por separado en el diagnóstico de TB en pacientes con VIH, aumentando su rendimiento diagnostico cuando se combinan

Predictive Models of Alcohol Use Based on Attitudes and Individual Values

Two predictive models are developed in this article: the first is designed to predict people's attitudes to alcoholic drinks, while the second sets out to predict the use of alcohol in relation to selected individual values. University students (N = 1,500) were recruited through stratified sampling based on sex and academic discipline. The questionnaire used obtained information on participants' alcohol use, attitudes and personal values. The results show that the attitudes model correctly classifies 76.3% of cases. Likewise, the model for level of alcohol use correctly classifies 82% of cases. According to our results, we can conclude that there are a series of individual values that influence drinking and attitudes to alcohol use, which therefore provides us with a potentially powerful instrument for developing preventive intervention programs.

Predictive ability of Genomic Estimated Family Values (GEFV).

Genomic selection (GS) has been used to compute genomic estimated breeding values (GEBV) of individuals; however, it has only been applied to animal and major plant crops due to high costs. Besides, breeding and selection is performed at the family level in some crops. We aimed to study the implementation of genome-wide family selection (GWFS) in two loblolly pine (Pinus taeda L.) populations: i) the breeding population CCLONES composed of 63 families (5-20 individuals per family), phenotyped for four traits (stem diameter, stem rust susceptibility, tree stiffness and lignin content) and genotyped using an Illumina Infinium assay with 4740 polymorphic SNPs, and ii) a simulated population that reproduced the same pedigree as CCLONES, 5000 polymorphic loci and two traits (oligogenic and polygenic). In both populations, phenotypic and genotypic data was pooled at the family level in silico. Phenotypes were averaged across replicates for all the individuals and allele frequency was computed for each SNP. Marker effects were estimated at the individual (GEBV) and family (GEFV) levels with Bayes-B using the package BGLR in R and models were validated using 10-fold cross validations. Predicted ability, computed by correlating phenotypes with GEBV and GEFV, was always higher for GEFV in both populations, even after standardizing GEFV predictions to be comparable to GEBV. Results revealed great potential for using GWFS in breeding programs that select families, such as most outbreeding forage species. A significant drop in genotyping costs as one sample per family is needed would allow the application of GWFS in minor crops.

Image calibration to like-values in mapping shallow water quality from multitemporal data

The applicability of image calibration to like-values in mapping water quality parameters from multitemporal images is explored, Six sets of water samples were collected at satellite overpasses over Moreton Bay, Brisbane, Australia. Analysis of these samples reveals that waters in this shallow bay are mostly TSS-dominated, even though they are occasionally dominated by chlorophyll as well. Three of the images were calibrated to a reference image based on invariant targets. Predictive models constructed from the reference image were applied to estimating total suspended sediment (TSS) and Secchi depth from another image at a discrepancy of around 35 percent. Application of the predictive model for TSS concentration to another image acquired at a time of different water types resulted in a discrepancy of 152 percent. Therefore, image calibration to like-values could be used to reliably map certain water quality parameters from multitemporal TM images so long as the water type under study remains unchanged. This method is limited in that the mapped results could be rather inaccurate if the water type under study has changed considerably. Thus, the approach needs to be refined in shallow water from multitemporal satellite imagery.