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PubMed1994

A new rapid immunoinhibition pancreatic amylase assay: diagnostic value for pancreatitis.

A new rapid immunoinhibition pancreatic amylase assay was compared to total amylase and lipase in an unbiased sample of 1005 emergency department patients with suspicion of pancreatitis, of which 55 had a final diagnosis of pancreatitis. Imprecision of the assays for both amylases (less than 2.5%) were better than for lipase (less than 6.1%). Correlation (R2) of pancreatic amylase with total amylase was 0.991 but only 0.789 with lipase. Using Receiver Operator Characteristics analysis, the best diagnostic cutoff point for all three enzymes was near the upper limit of the reference interval. With pancreatic amylase, sensitivity, specificity, and predictive values for positive and negative results are, respectively, 85.5, 92.5, 39.8, and 99.1%; we found similar values for lipase but poorer values (78.2, 92.0, 36.1, and 98.7%) for total amylase. Tests combination did not improve the diagnostic performance significantly. In the diagnosis of pancreatitis, pancreatic amylase (p = 0.037) and lipase (p = 0.049) had better diagnostic performance than total amylase. The correct diagnosis of pancreatitis could be achieved in 47 instead of 43 patients with either pancreatic amylase or lipase as opposed to total amylase among 1005 patients in this study. We conclude that pancreatic amylase and lipase are incrementally better diagnostic tools than total amylase for the diagnosis of pancreatitis.

Acute Disease↗
PubMed2003

[Transcranial color Doppler sonography (TCCD) in the diagnosis of vasospasm in the middle cerebral artery. Evaluation of TCCD diagnostic effectiveness by means of receiver operating characteristics curve (ROC) analysis].

Transcranial Doppler sonography is commonly used for diagnosis of cerebral vasospasm. However, the overall diagnostic performance of this method in detection of arterial narrowing has not been established. Blood velocity threshold, diagnostic for vasospasm, has been proposed for conventional, "blind" transcranial Doppler sonography (TCD). Nevertheless it cannot be used for transcranial color Doppler sonography (TCCD), because in this method the obtained blood velocities in the major cerebral arteries are higher than are in TCD. The aim of this study was to estimate the accuracy of transcranial color Doppler sonography in detection of middle cerebral artery (MCA) narrowing by means of receiver operating characteristic curve analysis (ROC). One hundred thirty four patients were studied with TCCD immediately before cerebral angiography. There were 75 men and 59 women, age range from 18 to 74 years, mean age 49 years. Of the 268 MCAs examined, 227 arteries were finally included in the construction of the ROC curve. Angiographic vasospasm was graded as none, mild (equal to or less than 25% of vessel caliber reduction--16 patients) and moderate-to-severe (more than 25% of vessel caliber reduction--29 patients). The overall diagnostic performance of transcranial color Doppler sonography in the detection of moderate-to-severe vasospasm of middle cerebral artery was found to be very high. The value of associated area under the ROC curve was 0.94. The value of this area for all vasospasms was 0.85, and this indicates good accuracy of a test. The best performing TCCD parameter for the detection of MCA narrowing was revealed to be peak-systolic velocity. The optimal trade-off between sensitivity and specificity was achieved with a peak systolic velocity of 182 cm/s. Therefore this velocity threshold is proposed as most universal for the diagnosis of vasospasm in the middle cerebral artery.

Adolescent↗
PubMed1983

[Evaluation of myocardial infarction by thallium emission computed tomography].

Thallium myocardial emission computed tomography (ECT) using a rotating gamma camera was undertaken to assess three-dimensional thallium distribution in the myocardium in cases with myocardial infarction (MI). Ninety-one cases with MI and 29 normal persons were examined by thallium ECT and the conventional planar imaging. Diagnostic performance and quantification of MI, and characterization of non-transmural MI were also investigated. In the detection of a perfusion defect, the ECT imaging showed significantly higher sensitivity (96%) than the planar imaging (77%) (p less than 0.001), especially in those with inferior wall MI (95% vs 73%, p less than 0.02) and nontransmural MI (82% vs 27%) (p less than 0.01). The specificity was the same in both techniques (90%), and therefore, higher overall accuracy was obtained by the ECT imaging (94%) than by the planar imaging (80%) (p less than 0.01). The receiver operating characteristic (ROC) curves were obtained from three independent observers for quantitative evaluation of observer detection performance. The ECT curves in each observer were situated in the upper left corner, indicating excellent diagnostic performance. Infarct size was estimated from the extent of the perfusion defect expressed as a percentage of the planar imaging (% defect) and as a volume of the infarcted myocardium (infarct volume). Those parameters were significantly correlated with peak CPK (r = 0.80 and 0.94, respectively), and inversely correlated with left ventricular ejection fraction (r = -0.78 and -0.85, respectively). Thus, the infarct volume calculated from the ECT is considered to permit estimation of infarct size more accurately than % defect from the planar imaging. To characterize nontransmural MI, 11 cases with nontransmural MI were examined by ECT and the findings were compared with those of transmural MI. A perfusion defect was detected in nine of the 11 patients (82%). As compared to those with transmural MI, infarct volume was smaller and the residual activity in an infarct region was higher in cases with nontransmural MI. Thus, the thallium ECT imaging, providing any-angle multisection of the myocardium, permits qualitative and quantitative evaluation of MI accurately.

Humans↗
PubMed2006

Performance of an automated computer-based scoring method to assess joint space narrowing in rheumatoid arthritis: a longitudinal study.

OBJECTIVE: To compare the diagnostic performance of a computer-based method for measuring joint space width with the Sharp joint space narrowing (JSN) scoring method in patients with rheumatoid arthritis (RA). METHODS: A random sample of patients with early RA, for whom sequential hand radiographs and Sharp scores were available, was selected from the National Data Bank for Rheumatic Diseases. Hand joint space width was measured using an automated, computer-based method in random order and with blinding for clinical information. We constructed a receiver operating characteristic curve and compared the diagnostic performance of the computer-based and Sharp methods based on the areas under the curve. RESULTS: One hundred twenty-nine patients with early RA who underwent serial radiography were included. Changes in the computer-based and Sharp methods were highly correlated (r = 0.75, P < 0.001). The computer-based method was significantly more discriminant than the Sharp JSN subscale. The area under the curve of the computer-based method was 0.96 (95% confidence interval [95% CI] 0.94, 0.99) compared with 0.93 (95% CI 0.89, 0.96) for the Sharp subscale (P = 0.024). At the most discriminant cutoff, specificity of the computer-based method was 88.4% compared with 81.4% for the Sharp subscale (P = 0.11); sensitivity was 87.6% for the computer-based method compared with 82.2% for Sharp subscale (P = 0.19). The signal-to-noise ratio for the computer-based method was 83% compared with 70% for the Sharp subscale (P = 0.013). CONCLUSION: The computer-based method for measuring joint space width is more discriminant than the semiquantitative Sharp JSN subscale.

Adult↗
PubMed1996

Costs and Benefits of Office Diagnostic Hysteroscopy

In Italy, the main location for performing diagnostic hysteroscopy is the office. The success of office hysteroscopy is related to savings of time and money and the convenience for the physician and patient. We evaluated 4000 diagnostic hysteroscopies performed between January 2, 1989, and March 1, 1996. In 17.8% of these patients we subsequently performed operative hysteroscopies (metroplasty, synechiolysis, myomectomy, polypectomy for polyps >2 cm), and in 5.2% a total abdominal hysterectomy for abnormal uterine bleeding or endometrial cancer. The low percentage of operations underlines the efficacy of office diagnostic hysteroscopy, especially if we evaluate costs and accuracy of this procedure in detecting uterine pathologies.

Journal Article↗
PubMed2000

Systematic review of clinical prediction rules for neuroimaging in the evaluation of dementia.

BACKGROUND: Clinical practice guidelines for dementia do not recommend routine neuroimaging but vary in their recommended clinical prediction rules to identify patients who should undergo neuroimaging for potentially reversible causes of dementia. METHODS: Using a MEDLINE search supplemented by other strategies, we identified studies from January 1, 1983, through December 31, 1998, that evaluated the diagnostic performance of a clinical prediction rule. We calculated the sensitivity and specificity of each rule, then evaluated their diagnostic performance in a hypothetical cohort of 1000 patients with dementia, varying the prevalence of potentially reversible dementia from 1% to 15%. RESULTS: We identified 7 studies that evaluated at least 1 of 6 different clinical prediction rules. Only one rule consistently had high sensitivity (>85%) across all studies; none consistently had high specificity (>85%). Six of the 7 studies included less than 15 cases of potentially reversible dementia; thus the sensitivity and specificity for each rule had relatively wide confidence intervals. At a 5% prevalence of potentially reversible dementia, all rules had low positive predictive value (<15%) in our hypothetical cohort. Depending on the rule, our analysis predicts 6 to 44 of the 50 patients with potentially reversible dementia (5% prevalence in cohort of 1000 patients) would not undergo imaging. CONCLUSIONS: There is considerable uncertainty in the evidence underlying clinical prediction rules to identify which patients with dementia should undergo neuroimaging. Application of these rules may miss patients with potentially reversible causes of dementia.

Aged↗
PubMed2005

Branch duct-type intraductal papillary mucinous tumor: diagnostic value of multiplanar reformatted images in multislice CT.

The object of this study was to evaluate the usefulness of high-resolution multiplanar reformatted (MPR) images obtained by multislice CT in demonstrating connection between pancreatic cystic lesions and the main pancreatic duct. The study included 27 lesions with connection to the main pancreatic duct and 12 lesions without. All but one of the former lesions were branch duct-type intraductal papillary mucinous tumors (IPMTs). Oblique and curved MPR images with 0.5 mm continuous slices were generated from pancreatic-phase axial images reconstructed with 0.5 mm or 1 mm thickness at 0.5 mm intervals over a 260 mm field of view. The diagnostic capabilities for demonstrating connection with the main pancreatic duct were compared among axial images, MPR images, and both axial and MPR images in combination using the Brier score. The diagnosis in MPR images for demonstrating connection was more certain than that in axial images (P<0.05). Compared with MPR images alone, the use of both axial and MPR images resulted in further improvements in diagnostic performance, although the difference was not statistically significant. The use of high-resolution MPR images significantly improves diagnostic performance for demonstrating connection between pancreatic cystic lesions and the main pancreatic duct, which is useful for the diagnosis of branch duct-type IPMT.

Adenocarcinoma, Mucinous↗
PubMed1999

ST/HR hysteresis: exercise and recovery phase ST depression/heart rate analysis of the exercise ECG.

ST segment depression/heart rate (ST/HR) hysteresis is a recently introduced novel computer method for integrating the exercise and recovery phase ST/HR analysis for improved detection of coronary artery disease (CAD). It is a continuous diagnostic variable that extracts the prevailing direction and average magnitude of the hysteresis in ST depression against HR during the first 3 consecutive minutes of postexercise recovery. This article reviews the development and evaluation of this new method in a clinical population of 347 patients referred for a routine bicycle exercise electrocardiographic (ECG) test at Tampere University Hospital, Finland. Of these patients, 127 had angiographically proven CAD, whereas 13 had no CAD according to angiography, 18 had no perfusion defect according to Tc-99m-sestamibi myocardial imaging and single photon emission computed tomography, and 189 were clinically normal with respect to cardiac diseases. For each patient, the values for ST/HR hysteresis, ST/HR index, end-exercise ST depression, and recovery ST depression were determined for each lead of the Mason-Likar modification of the standard 12-lead exercise ECG and maximum value from the lead system (aVL, aVR, and V1 excluded). The area under the receiver operating characteristics curve (ie, the discriminative capacity) of the ST/HR hysteresis was 89%, which was significantly larger than that of the end-exercise ST depression (76%, P < .0001), recovery ST depression (84%, P = .0063) or ST/HR index (83%, P = .0023), indicating the best diagnostic performance of the ST/HR hysteresis in detection of CAD regardless of the partition value selection. Furthermore, the superior diagnostic performance of the method was relatively insensitive to the ST segment measurement point or to the ECG lead selection. These results suggest that the ST/HR hysteresis improves the clinical utility of the exercise ECG test in detection of CAD.

Adult↗
PubMed1995

Digital chest imaging using a selenium detector. A simulated diffuse interstitial pulmonary disease detection study.

RATIONALE AND OBJECTIVES: To assess the diagnostic performance of a new digital chest imaging system based on a selenium detector in the detection of simulated diffuse interstitial pulmonary disease (DIPD). METHODS: Diffuse interstitial pulmonary disease was simulated by superimposing plastic sheets containing small radio-paque objects (birdseed) on an anthropomorphic chest phantom. the number of sheets was varied from 0 to 4 to simulate the degree of pathology. Eighty conventional radiographs and 80 images with the selenium detector were obtained under comparable conditions. Six observers were asked to indicate the presence of DIPD using a five-level scale of confidence. The total 160 chest images were analyzed using receiver operating characteristic curves. RESULTS: There was no significant difference in detection performance between the conventional and the digital images (95% confidence interval). CONCLUSIONS: None of the observers assessed the diagnostic performance of the digital chest images as significantly different from that of the conventional system. The interobserver differences were higher than the differences between digital and conventional chest images.

Humans↗
PubMedDate not supplied

Comparison of dermatoscopic ABCD rule and risk stratification in the diagnosis of malignant melanoma.

For didactic and documentation purposes the dermatoscopic ABCD rule and the dermatoscopic risk stratification have been proposed. The aim of this investigation was to compare the ability of the 2 methods to separate patients with cutaneous malignant melanoma from individuals with other pigmented skin lesions. Three dermatologists, experienced users of dermatoscopy, assessed macroscopic clinical and dermatoscopic slides from 258 patients referred to the skin cancer outpatient clinic by the ABCD rule and risk stratification methods. Diagnostic performance of the 2 methods was compared by receiver operating characteristics curve analysis. When all pigmented skin lesions were compared, there was a trend for the observers to perform better using risk stratification. When only lesions with a well-defined pigment network were included, the diagnostic performance of the risk stratification method was superior to the dermatoscopic ABCD rule (areas under the receiver operating characteristics curve median 0.93 vs. 0.80, p<0.004) for all observers. The agreement between the 2 methods was moderate to substantial (kappa coefficient 0.53-0.62). More melanomas were identified when the rules were combined. The dermatoscopic ABCD rule has been accepted as a standard for identifying melanomas with the dermatoscope, but should be considered secondary to pigment network analysis.

Biopsy, Needle↗
PubMed2005

Normal D-dimer concentration is a common finding in symptomatic outpatients with distal deep vein thrombosis.

The D-dimer analysis has been shown to have a high sensitivity and a high negative predictive value for the exclusion of deep vein thrombosis (DVT). However, most D-dimer studies, including recent clinical management studies, are performed without examination of the calf veins and/or performed on patient populations with a predominance of proximal DVT. The purpose of this study was to evaluate the diagnostic performance of the D-dimer test in a population with a suspected high incidence of distal DVT. In the present study, 393 outpatients with clinically suspected symptomatic DVT of the lower extremities were examined with whole-leg duplex ultrasonography. The D-dimer analysis was performed using an automated micro-latex assay (Tina-quant). A total of 137 of 393 patients had a proven DVT, with the majority presenting with distal DVT (59%). Twenty-eight out of 81 patients with distal DVT had a normal D-dimer, compared with two of 56 patients with proximal DVT. The sensitivity for distal DVT was only 65% compared with 96% for proximal DVT; the negative predictive values were 84 and 99%, respectively. In conclusion, the prevalence of distal DVT in a study population seems to have a great impact on the diagnostic performance of the D-dimer analysis. The study results also show that normal D-dimer levels do not exclude distal DVT in outpatients; instead, it can be hypothesized that normal D-dimer levels exclude DVT that require treatment, as indicated by the good outcome in recent management studies.

Aged↗
PubMed2004

A systematic review of the performance of a laser fluorescence device for detecting caries.

BACKGROUND: The DIAGNOdent, or DD (KaVo America, Lake Zurich, Ill.), a device for detecting caries using laser fluorescence, has been growing in popularity during the past three years. Although several evaluations of its diagnostic performance have appeared in the literature, the range of reported performances is extensive. TYPES OF STUDIES REVIEWED: The authors conducted a systematic review of the literature to assess the diagnostic performance of the DD. Of 115 articles identified in the search, 25 studies were included in the review according to criteria requiring histologic validation and outcomes expressed as sensitivity and specificity values. RESULTS: For detection of dentinal caries, sensitivity values ranged widely (0.19 to 1.0), although most tended to be high. Specificity values exhibited a similar pattern, ranging from 0.52 to 1.0. In comparison with visual assessment methods, the DD exhibited a sensitivity value that was almost always higher and a specificity value that was almost always lower. The body of evidence is characterized largely by in vitro studies, so that generalization to the clinical setting is uncertain. Because caries thresholds varied substantially across the studies, synthesized estimates of performance were not possible. CONCLUSIONS AND CLINICAL IMPLICATIONS: The DD clearly is more sensitive than traditional diagnostic methods; however, the increased likelihood of false-positive diagnoses compared with that with visual methods limits its usefulness as a principal diagnostic tool.

Dental Caries↗
PubMed1986

Medical student training in the performance of diagnostic laboratory procedures.

A study was conducted to determine what diagnostic laboratory procedures medical students recalled being taught during pre-clerkship training, how well they felt they could perform these procedures on entrance to and exit from their clerkship year, and the estimate of frequency of personal performance during the clerkship year. Surveys were mailed to 223 graduating senior students of a medical school. They were asked to supply data regarding 15 pre-selected procedures. In only seven cases did a majority of students recall being taught a procedure. Higher percentages of students who trained at health science centres and a Veterans Administration hospital recalled being taught procedures compared to students who trained at community hospitals. In general, students who performed their pre-clerkship training at the health science centres rated their ability to perform procedures without assistance on entrance to the clerkship year higher than the other two groups. Students who performed at least one half of their clerkships at a health science centre rated their ability to perform procedures without assistance at the termination of their clerkship year higher than those who performed a majority of clerkships at community hospitals. The former group also reported a higher frequency of performance of the procedures than the community hospital group. Most of the procedures for all groups, however, were performed at a rate of less than one/month.

Chicago↗
PubMed1996

Immune reactivity of cow-asthmatic dairy farmers to the major allergen of cow (BDA20) and to other cow-derived proteins. The use of purified BDA20 increases the performance of diagnostic tests in respiratory cow allergy.

BACKGROUND: Cow dust is one of the most important inducers of occupational allergic diseases in Finland. For example, in 1991 it accounted for almost 40% of the new occupational asthma cases. OBJECTIVE: This study compares the performance of the purified major cow allergen (BDA20) and crude bovine epithelial extract (BEA) in diagnostic tests and examines the role of milk allergy-associated bovine proteins (bovine serum albumin, alpha-lactalbumin, beta-lactoglobulin, casein) in respiratory cow allergy. METHODS: The humoral responses of cow-asthmatic and healthy farmers to the various components of BEA were analysed with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting. The levels of specific IgE and IgG antibodies were quantificated with enzyme-linked immunosorbent assays (ELISAs). The cellular responses were analysed with antigen-specific lymphocyte proliferation tests. RESULTS: The specific anti-BDA20 IgE measurement was found to be best in distinguishing between the asthmatic farmers and their healthy colleagues. It proved possible to determine a cut-off value that gave the analysis a specificity and sensitivity of 100%; the distinction between the two groups was highly significant (P < 0.0001). In the lymphocyte proliferation analysis, cow asthma was more closely associated with reactivity to BDA20 than to BEA. In the measurement of anti-BDA20 and anti-BEA IgG antibody levels, considerable overlap between the groups was observed, suggesting that these antibodies are not directly involved in cow allergy. When proteins associated with milk allergy were used as test reagents, no statistically significant differences could be observed between the groups, except for anti-casein IgE antibodies the level of which, however, overlapped considerably between the farmer groups. CONCLUSION: These findings suggest that purified BDA20 is better than BEA for diagnosing cow asthma and that proteins associated with milk allergy are of only marginal significance in this disease.

Adult↗
PubMed1996

Spatial resolution requirements in digital radiography of scaphoid fractures. An ROC analysis.

PURPOSE: To investigate the spatial resolution requirements in digital radiography of scaphoid fractures. MATERIAL AND METHODS: Included in the study were 60 scaphoid radiographs with and 60 without fractures of the scaphoid bone. The film-screen images were digitized using pixel sizes of 115, 170, and 340 microns along with 170 microns with a 10:1 wavelet compression. The digital images were displayed on a 1280 x 1024 x 8 bits monitor, and 5 observers evaluated the images in 5 randomized sessions. The results for each pixel size were then compared to the film-screen images by ROC analysis. RESULTS: The mean area under the ROC curves was larger for the film-screen images than for the digital images at all resolutions. However, this difference was not significant when the areas under the ROC curves for the film-screen images were compared to the digital images of 115, 170, and 170 microns with 10:1 compression. There was a significant difference for the 340-microns pixel size in favour of the film-screen images. The mean ROC curves for the digital images were very similar for the 115 and 170 microns pixel sizes, although slightly better for 115 microns. At 170 microns, the compression seemed to have a relatively small negative effect on the diagnostic performance; the deterioration was greater when the pixel size was increased to 340 microns. There was no obvious correlation between diagnostic performance and the experience of the observers in using work-stations. CONCLUSIONS: The pixel size of 170 microns is adequate for the detection of subtle fractures, even after wavelet compression by a ratio of 10:1.

Angiography, Digital Subtraction↗
PubMedDate not supplied

CT of metal implants: reduction of artifacts using an extended CT scale technique.

PURPOSE: The purpose of this work was to use an extended CT scale technique (ECTS) to reduce artifacts due to metal implants and to optimize CT imaging parameters for metal implants using an experimental model. METHOD: Osteotomies were performed in 20 porcine femur specimens. One hundred cobalt-base screws and 24 steel plates were used for osteosynthesis in these specimens. Artificial lesions were produced in 50 screws, such as osteolysis near the screws (mimicking lysis due to infection, tumor, or loosening), displacement of the screws, as well as fractures of the screws. All specimens were examined using eight different CT protocols: four conventional (CCT) and four spiral (SCT) CT protocols with different milliampere-second values (130 and 480 mAs for CCT, 130 and 300 mAs for SCT), kilovolt potentials (120 and 140 kVp), and slice thicknesses (2 and 5 mm). The images were analyzed by three observers using a standard window (maximum window width 4,000 HU) and ECTS (maximum window width 40,000 HU). Receiver operating characteristic analysis was performed, and image quality was assessed according to a five level scale. RESULTS: Metal artifacts were significantly reduced using ECTS (p < 0.05). The highest diagnostic performance was obtained using ECTS with the thinnest slice thickness. Metal artifacts were more pronounced using SCT. In this experimental model, exposure dose and kilovolt potential had no significant impact on diagnostic performance (p > 0.05). CONCLUSION: ECTS improved imaging of metal implants. In this study, no significant effects of exposure dose and kilovolt potential were noted. Metal artifacts were more prominent using SCT than using CCT.

Animals↗
PubMed1999

[Quality management in histopathology. "From biopsy to diagnosis"].

UNLABELLED: The University Institute of Pathology (IUP), Lausanne, has established a system designed to continuously document and manage the quality of its diagnostic activity in surgical pathology. To realize the system a few tools were created. Several "free codes" were introduced into the general computer system in order to register and evaluate (1) the quality of frozen section diagnoses, (2) the relevance of the use of this type of examination and (3) the frequency of spontaneous "official" internal consultations in search of a second opinion. Further, an evaluation checklist including all steps leading to the diagnosis (some of which were facultative*) was established. Eleven items were evaluated and registered in this way: quality of slides and staining, reporting time, selection of tissue blocks*, macro- and microscopic descriptions*, appropriateness of special stains and/or techniques and their quality*, final diagnosis, accuracy of codes for invoicing and diagnoses, quality of the final report. The relevance of the furnished clinical data was also evaluated and recorded. RESULTS: Of all registered frozen section examinations (397), 86.6% showed identity of provisional and definitive diagnoses. In 11.6% of cases there was a difference between the two diagnoses without clinical relevance, and in 1.8% the discrepancy was clinically significant. These percentages are comparable with those published in the literature. Internal consultation for second opinion is a current habit in our institution, and 980 cases (4%) were registered as such. Among the 25,249 cases received for histopathological examination during 1998 (each case may concern more than one specimen from the same patient), 495 (2% = 2-3 cases/day) were evaluated in detail by two reviewers throughout the year. The statistical results obtained demonstrate that our diagnostic performance in histopathology is very satisfactory: 43% of the analysed cases bear no deficit and 67.3% present two or less points in deficit; no diagnostic error was evidenced; 70% of the reports are signed-out within 3 days after reception of the material (mean delay < 3 days). CONCLUSIONS: The adopted system represents an excellent tool by which to continuously document and manage the quality of our diagnostic performances. It is reliable, efficient, sensitive and also feasible, as it does not require significant or exaggerated additional investments. The results obtained after one year confirm the high quality of the IUP's diagnostic activity.

Biopsy↗
PubMed2004

Depression in dementia: a comparative and validation study of four brief scales in the elderly Chinese.

AIM: The study aimed to determine: (i) the diagnostic accuracy of four brief depression scales, the Geriatric Depression Scale (GDS), Even Briefer Assessment Scale for Depression (EBAS DEP), Single Question and Cornell Scale for Depression in Dementia (Cornell) in an elderly Chinese population with varying dementia severity; and (ii) which scale had the best diagnostic performance. METHOD: All four scales were administered to 88 elderly outpatients with dementia: 66 without and 22 with depression. Receiver Operating Characteristic (ROC) analysis was used to establish the optimal cut-off scores of the GDS, EBAS DEP and Cornell scales. The patients' dementia-severity was dichotomously categorized into mild and moderate-severe dementia, and the above analysis was repeated in both these groups to look at changes in the scales' diagnostic performance as dementia advances. RESULTS: The best diagnostic scale for detecting depression in dementia was the Cornell scale. Its optimal cut-off score was 6/7 (sensitivity 91.7%, specificity 80.0%) in the mild dementia group and 12/13 (sensitivity 70.0%, specificity 87.0%) in the more advanced dementia group. The optimal cut-off scores of the GDS and EBAS DEP also shifted to higher values when moving from the mild to the more advanced dementia groups, indicating the increasing difficulty on all these scales to detect depression with worsening cognitive impairment. The Single Question, however, was more robust with much less changes in its diagnostic parameters in both dementia cohorts: sensitivity 58.3%, specificity 90.0% for mild dementia, and 60.0 and 84.8%, respectively, for more advanced dementia. CONCLUSION: An efficient strategy to diagnose depression in dementia amongst elderly Chinese patients is to administer the Single Question followed by, when necessary, the Cornell scale.

Aged↗