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PubMed1991

[Age and pulmonary function testing in predicting postoperative morbidity after thoracic surgery].

In order to evaluate whether age and pulmonary function testing may predict postoperative morbidity and mortality in the patients having received thoracic surgery, 203 patients were included in this study. Spirometry, flow volume curve, lung volume determination and arterial blood gas analysis were performed in all of them. Postoperative complications were classified into respiratory complications including pneumonia, purulent bronchitis, atelectasis, respiratory failure and so on; and non-respiratory complications including subcutaneous emphysema, internal bleeding, stump leakage, dysarrythmia and so on. Of the 117 patients over 65 years of age, 27 (23.1%) had postoperative respiratory complications, 27 (23.1%) had non-respiratory complications, and 7 (5.93%) expired postoperatively. Of the 86 patients under 65 years of age, 21 (24.4%) had postoperative respiratory complications and 9 (7.6%) had postoperative non-respiratory complications, but one expired. The incidences of postoperative mortality and non-respiratory complications were both higher in the patients over 65 years of age (p less than 0.05). Our results indicated that age is a risk factor of thoracic surgery, even if the pulmonary function testing meet the surgical criteria.

Age Factors↗
PubMed2005

Interleukin (IL)-1A and IL-6: applications to the predictive diagnostic testing of radiation pneumonitis.

PURPOSE: To explore the application of interleukin (IL)-1alpha and IL-6 measurements in the predictive diagnostic testing for symptomatic radiation pneumonitis (RP). METHODS AND MATERIALS: In a prospective protocol investigating RP and cytokines, IL-1alpha and IL-6 values were analyzed by enzyme-linked immunosorbent assay from serial weekly blood samples of patients receiving chest radiation. We analyzed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) over selected threshold values for both cytokines in the application to diagnostic testing. RESULTS: The average coefficient of variation was 51% of the weekly mean IL-1alpha level and 39% of the weekly mean IL-6 value. Interleukin 1alpha and IL-6 became positively correlated with time. Specificity for both cytokines was better than sensitivity. IL-6 globally outperformed IL-1alpha in predicting RP, with higher PPV and NPV. CONCLUSIONS: Our data demonstrate the feasibility of applying IL-1alpha and IL-6 measurements of blood specimens to predict RP. Interleukin-6 measurements offer stronger positive predictive value than IL-1alpha. This application might be further explored in a larger sample of patients.

Adult↗
PubMed1994

Testing for predictive validity in health care education research: a critical review.

BACKGROUND: The assessment of predictive validity is the essential core from which a sound model of prediction is built. METHOD: Three methods for assessing predictive validity in health care education research were reviewed: longitudinal profile development, cross-validation, and inspection of the adjusted R2. A total of 47 articles published between 1973 and 1993 in nine health care disciplines were critically reviewed to determine whether the studies tested for predictive validity by using these methods. RESULTS: Very few of the 47 studies used at least one of the three methods for assessing predictive validity. Furthermore, the proportion of variance explained that is reported in the articles is typically small even before assessment of predictive validity. It is sobering to note that these small values may be inflated, since shrinkage is likely to occur when assessing predictive validity on a second, or cross-validation, sample. CONCLUSION: The scarcity of testing of predictive validity in the studies reviewed highlights the necessity of future research to establish the degree of predictive validity, if improvements in predicting success in health care education research are to be realized.

Education↗
PubMed2001

Value of combinations of pancreatic function tests to predict mild or moderate chronic pancreatitis.

UNLABELLED: Pancreatic function tests share an insufficient accuracy concerning the detection of mild or moderate forms of chronic pancreatitis. It was evaluated here whether by combination of different assays the prediction or exclusion of chronic pancreatitis could be improved. METHODS: 62 patients with chronic abdominal pain and suspected chronic pancreatitis underwent an endoscopic retrograde pancreaticography. The duct alterations were classified according to the Cambridge criteria. In all individuals the pancreolauryl test in serum (PLT-S) and urine (PLT-U) was performed and elastase 1-immunoreactivity (E) as well as chymotrypsin (Chy) activity in stool were measured. Sensitivities, specificities, receiver-operator-curves as well as cut-off points at optimal accuracies were calculated for each single assay and all test combinations. Cut offs were optimized by a mathematical model to achieve highest accuracies. RESULTS: In 30 patients the pancreatic duct was normal and in 32 patients alterations of the duct system were found. These were classified as mild in 10 patients, as moderate in 8 patients and as severe in 14 patients. In those with mild and moderate disease all pancreatic function tests showed sensitivities/specificities of 60-65% and 65-70%, respectively. Only in severe chronic pancreatitis elastase was superior to the other tests. Combinations of function tests did not lead to improved accuracy. After mathematical optimization the accuracy (sensitivity 80%, specificity 80%) was best for the combination of PLT-S (cut off 4.7 micrograms/ml) and E (cut off 500 micrograms/g). Both parameters had to be below these newly defined cut offs to diagnose chronic pancreatitis. CONCLUSIONS: The accuracy of pancreatic function tests may be improved by use of altered cut offs and a combination of serum pancreolauryl test and elastase. These newly defined cut offs will have to be evaluated in a much larger study.

Adult↗
PubMed2003

Genetics and clinical practice in rheumatology.

The dramatic advances made recently in human genome research are fueling considerable interest in genetic testing. A specific feature of genetic testing is that the results are final and impact not only the patient, but also the entire family. Those elements should be factored into the risk/benefit ratio evaluation. In France, legislation the differentiates diagnostic tests in symptomatic patients from predictive tests in asymptomatic patients with affected family members. Only multidisciplinary groups with both clinical and genetic expertise can order predictive tests. In all cases the physician must sign a statement that informed consent was obtained from the patient prior to testing. The test must be done in an accredited laboratory and the result communicated by the physician to the patient. Patient confidentiality must be respected, particularly regarding family members. In monogenic diseases, the diagnostic weight of genetic testing is often considerable, although the limitations should be borne in mind. In multifactorial diseases, genetic testing seeks to identify risk factors that are usually associated with a low level of risk. The result should be interpreted in the light of the clinical presentation, family history, and genetic background. The predictive value is closely dependent on the clinical presentation but is generally limited, most notably when family members are affected. Great care should be taken to avoid causing undue anxiety among individuals with positive test results. Diseases that illustrate these aspects include Paget's disease of bone, of which inherited variants caused by a mutation in a single gene on chromosome 5 have been identified recently, and rheumatoid arthritis, which is a multifactorial disease.

Connective Tissue Diseases↗
PubMedDate not supplied

Usefulness of the hypo-osmotic swelling test in predicting pregnancy rate and outcome in couples undergoing intrauterine insemination.

This study was designed to evaluate the usefulness of the hypo-osmotic swelling (HOS) test in predicting successful conception and the pregnancy outcome in couples in whom men are affected by mild infertility and fertile women are treated with ovulation induction and intrauterine insemination (IUI). We retrospectively analyzed the results obtained from 120 couples who underwent not more than 3 consecutive cycles of gonadotropin-induced mono-ovulation followed by IUI. Semen was analyzed by classical parameters, and the HOS test was performed using a hypo-osmotic solution. Using HOS, at least 50% swollen spermatozoa was considered normal. The pregnancy rate obtained in couples with an HOS less than 50% was significantly lower (P <.05) than that achieved in couples with HOS values at least 50%. Furthermore, the miscarriage rate was higher when HOS was less than 50%. For prediction of successful pregnancy, the sensitivity and specificity of the HOS test was 64% and 75%, respectively; the predictive value of an abnormal test was 94%, and that of a normal test was 24%. The HOS test may detect subtle damage in spermatozoan structure, which is responsible for the reduced capacity of spermatozoa to induce a viable embryo, with a low rate of pregnancy and a high rate of miscarriage. The results suggest that the HOS test may help in recognizing men who have a poor chance of fertilizing their partners and to have viable pregnancies using IUI.

Adult↗
PubMed2004

Reliability of electrophysiologic anal tests in predicting the outcome of sacral nerve modulation for fecal incontinence.

INTRODUCTION: Sacral nerve modulation has been demonstrated to be a new efficacious treatment for fecal incontinence. The effectiveness of the procedure is preliminarily tested by means of a peripheral nerve evaluation. Integrity of the sacral neural pathway is generally believed to be a necessary condition for a good response, but no data are available to confirm whether electrophysiologic anal tests are predictive of the clinical outcome of the peripheral nerve evaluation. METHODS: Eighty-two incontinent patients underwent the peripheral nerve evaluation after full evaluation of the anorectal physiology. Univariate analysis was performed, and the positive predictive value, sensitivity, and specificity were calculated for each of the tests. RESULTS: Forty-six patients had successful results to the peripheral nerve evaluation and were subjected to permanent implant of a sacral electrostimulator. Anal sphincter electromyography had been performed in 60 patients, whereas pudendal nerve terminal motor latency had been assessed in 68 and evoked sacral potentials in 29 patients. Anal electromyography was statistically related to the outcome of the peripheral nerve evaluation ( P = 0.0004) with a positive predictive value of 81 percent, a sensitivity of 44 percent, and a specificity of 81 percent. Pudendal nerve terminal motor latency on the right side did not correlate with the outcome, but left pudendal nerve terminal motor latency was weakly correlated ( P = 0.02), although both tests had a low positive predicting value and sensitivity vs. good specificity. Evoked sacral potentials did not correlate with the outcome and had a low positive predictive value, sensitivity, and specificity. CONCLUSIONS: Simple anal sphincter electromyography can predict the outcome of the peripheral nerve evaluation with good positive predictive value and specificity in patients with fecal incontinence. Other, more expensive, electrophysiologic anal tests do not add further prognostic information.

Aged↗
PubMed1992

The diffusion of new genetic tests for predicting disease.

This paper examines the pathways by which new genetic tests will become available to the public. In view of the scarcity of genetic specialists, the pathway is likely to involve primary care physicians. Other pathways entail state-mandated testing, community-based programs, or testing by laboratories without much involvement of primary care physicians. When testing does become available the "destination" will be either family-centered testing or population-oriented screening. The deterrent to screening will not be the inability to detect disease-causing mutations but the costs and attitudes of providers and the public. When tests are provided primarily to provide information about risks to future children, some people will oppose screening on religious or moral grounds. When there are no inexpensive treatments, some will fear that insurance companies and employers will use tests to deny them health care coverage. Some may not want to know their risks for disorders about which little can be done. For common, multifactorial disorders, genetic tests will have low predictive value. Because of these problems, the decision to be tested, regardless of the destination, requires that "testees" be fully informed and consent to testing. When acceptance rates are low, screening is less likely to be cost-effective; family-centered testing becomes the default destination.

Genetic Diseases, Inborn↗
PubMed2000

Mid-trimester beta-hCG levels incorporated in a multifactorial model for the prediction of severe pre-eclampsia.

Pre-eclampsia remains a major cause of perinatal morbidity and mortality worldwide. Proposed predicting tests for early detection of pregnant women destined to develop pre-eclampsia remain unsatisfactory. The aim of this study was to investigate the clinical utility of combining mid-trimester maternal serum beta-human chorionic gonadotrophin (MShCG) levels with selected clinical determining factors as a multifactorial predictive test for pre-eclampsia. Thirty-nine cases with mild pre-eclampsia and 56 with severe pre-eclampsia were recruited as the study groups. Normotensive women (957) were enrolled as controls. Potential determining risk factors for severe pre-eclampsia were selected using a multiple logistic regression to build various combined prediction models. A receiver-operator characteristic curve was employed to assess the performance of each prediction test for pre-eclampsia. The prediction efficacy of each test was examined by the area under the curve (AUC). Our data show that mid-trimester MShCG levels significantly correlated with severity of pre-eclampsia (Spearman rank correlation coefficient=0.195, p<0.001). Women with mild pre-eclampsia had a 2.61-times greater chance, while women with severe pre-eclampsia had a 6.13-times greater chance of having MShCG exceeding 2.0 multiples of the median than did women with a normal pregnancy. A combined prediction model composed of MShCG levels, body mass index (BMI), parity, and age as a predictive test for severe pre-eclampsia was superior to MShCG levels alone (AUC 0.765 versus 0.648). The integrated multifactorial model could identify women at risk early on for developing severe pre-eclampsia, with a sensitivity of 70% and a specificity of 71%. Thus, we demonstrate a potentially effective and convenient method by which women at risk for developing severe pre-eclampsia can be identified early, based on a multifactorial predictive model composed of midtrimester MShCG levels, BMI, parity, and age.

Adult↗
PubMed2005

Men's decision-making about predictive BRCA1/2 testing: the role of family.

Men who have a family history of breast and/or ovarian cancer may be offered a predictive genetic test to determine whether or not they carry the family specific BRCA1/2 mutation. Male carriers may be at increased risk of breast and prostate cancers. Relatively little is known about at-risk men's decision-making about BRCA1/2 testing. This qualitative study explores the influences on male patients' genetic test decisions. Twenty-nine in-depth interviews were undertaken with both carrier and noncarrier men and immediate family members (17 male patients, 8 female partners, and 4 adult children). These explored family members' experiences of cancer and genetic testing, decision-making about testing, family support, communication of test results within the family, risk perception and risk management. Implicit influences on men's testing decisions such as familial obligations are examined. The extent to which other family members--partners and adult children--were involved in testing decisions is also described. It is demonstrated that mothers of potential mutation carriers not only perceive themselves as having a right to be involved in making this decision, but also were perceived by their male partners as having a legitimate role to play in decision-making. There was evidence that (adult) children were excluded from the decision-making, and some expressed resentment about this. The implications of these findings for the practice of genetic counseling are discussed.

Attitude↗
PubMed1998

Personality disorders and the five-factor model: a test of facet-level predictions.

We tested predicted relationships (Widiger, 1993; Widiger, Trull, Clarkin, Sanderson, & Costa, 1994) between personality disorder scores and facets of the five-factor model, and evaluated the relative benefits of facet-level analyses over domain-level analyses. Data from 614 undergraduates indicated: (a) 63% of the predicted facet relationships were significant, although many unpredicted relationships also emerged; (b) facet-level analyses did not yield substantially stronger effect sizes than domain-level analyses; but (c) facet-level analyses provided much better discrimination between personality disorders than domain-level analyses. Facets of the openness to experience domain also helped discriminate between personality disorders, which is in contrast to previous domain-level findings that openness is not important.

Adult↗
PubMed2004

The role of chlamydia genus-specific and species-specific IgG antibody testing in predicting tubal disease in subfertile women.

BACKGROUND: We evaluated whether measuring chlamydia genus- and species-specific immunoglobulin (Ig) G antibodies might improve the predictive value of C. trachomatis antibody testing (CAT) in screening for distal tubal pathology (DTP). METHODS: Serum of 313 subfertile women was tested for the presence of species-specific antibodies to C. trachomatis, C. pneumoniae and C. psittaci and genus-specific antibodies to chlamydia lipopolysaccharide (LPS). Only patients who had undergone a laparoscopy with tubal testing, to assess the grade of DTP, were included in this study. RESULTS: The presence of C. trachomatis antibodies was the only independent predictor for DTP. The predictive value of CAT for DTP could not be improved by adding test results of C. pneumoniae or LPS antibody testing. The role of C. psittaci could not be evaluated, due to the absence of C. psittaci-positive patients in our cohort. CONCLUSIONS: In spite of the high interspecies homology, C. pneumoniae does not contribute to the development of DTP. Anti-LPS antibodies, which are considered to be markers for ongoing infections, do not identify C. trachomatis-positive subfertile women who are at highest risk of DTP. The high prevalence of anti-LPS antibodies in C. trachomatis-positive subfertile women may suggest that C. trachomatis remains more active in the upper genital tract than currently is presumed.

Adult↗
PubMed1982

Usefulness and limitations of various guinea-pig test methods in detecting human skin sensitizers-validation of guinea-pig tests for skin hypersensitivity.

Several guinea-pig predictive test methods were evaluated by comparison of results with those obtained with human predictive tests, using ten compounds that have been used in cosmetics. The method involves the statistical analysis of the frequency with which guinea-pig tests agree with the findings of tests in humans. In addition, the frequencies of false positive and false negative predictive findings are considered and statistically analysed. The results clearly demonstrate the superiority of adjuvant tests (complete Freund's adjuvant) in determining skin sensitizers and the overall superiority of the guinea-pig maximization test in providing results similar to those obtained by human testing. A procedure is suggested for utilizing adjuvant and non-adjuvant test methods for characterizing compounds as of weak, moderate or strong sensitizing potential.

Allergens↗
PubMedDate not supplied

Soil testing to predict phosphorus leaching.

Subsurface pathways can play an important role in agricultural phosphorus (P) losses that can decrease surface water quality. This study evaluated agronomic and environmental soil tests for predicting P losses in water leaching from undisturbed soils. Intact soil columns were collected for five soil types that a wide range in soil test P. The columns were leached with deionized water, the leachate analyzed for dissolved reactive phosphorus (DRP), and the soils analyzed for water-soluble phosphorus (WSP), 0.01 M CaCl2 P (CaCl2-P), iron-strip phosphorus (FeO-P), and Mehlich-1 and Mehlich-3 extractable P, Al, and Fe. The Mehlich-3 P saturation ratio (M3-PSR) was calculated as the molar ratio of Mehlich-3 extractable P/[Al + Fe]. Leachate DRP was frequently above concentrations associated with eutrophication. For the relationship between DRP in leachate and all of the soil tests used, a change point was determined, below which leachate DRP increased slowly per unit increase in soil test P, and above which leachate DRP increased rapidly. Environmental soil tests (WSP, CaCl2-P, and FeO-P) were slightly better at predicting leachate DRP than agronomic soil tests (Mehlich-1 P, Mehlich-3 P, and the M3-PSR), although the M3-PSR was as good as the environmental soil tests if two outliers were omitted. Our results support the development of Mehlich-3 P and M3-PSR categories for profitable agriculture and environmental protection; however, to most accurately characterize the risk of P loss from soil to water by leaching, soil P testing must be fully integrated with other site properties and P management practices.

Agriculture↗
PubMed1987

The role of aquatic toxicity tests in predicting and monitoring pollution effects.

The complementary role of aquatic toxicity tests in relation to other forms of pollution assessment is discussed. These tests may be predictive and designed to estimate hazard, or used for monitoring waters to assess compliance with standards. The effects of pollutants are significantly modified by certain water quality characteristics and by a variety of biological factors. The latter, particularly those causing physiological stress, are discussed.

Aging↗
PubMed1993

A short cycle ergometer test to predict maximal workload and maximal oxygen uptake.

In order to develop a short cycle ergometer test for the prediction of maximal oxygen uptake (VO2max) and maximal work load (Wmax) oxygen uptake, workload and heart rate data were collected in 22 subjects. In the first test the subjects cycled at two submaximal stages of 3 min each whereafter the workload was quickly (within 4 min) increased to a supramaximal level to attain the maximal heart rate. A second graded cycle test was used to compare observed Wmax and VO2max with estimated Wmax and VO2max. The means of the estimated Wmax and observed Wmax were 364.9 (SD +/- 42.4) watts and 368.8 (SD +/- 40.2) watts, respectively and the mean estimation error was -1.0% (range -7.1% to 4.4%). For 82% of the subjects the estimation error was within +/- 5%. The means of the estimated VO2max and observed VO2max were 4.49 (SD +/- 0.45) l.min-1 and 4.59 (SD +/- 0.41) l.min-1, respectively. The mean estimation error was -2.1% (range -13.8% to 5.1%). For 68% of the subjects the estimation error was within +/- 5%. It is concluded that for trained athletes the short test (8-10 min) is accurate for the estimation of Wmax and VO2max by measuring two submaximal heart rates and maximal heart rate and making use of the linear relationship between heart rate, workload and oxygen uptake.

Adult↗
PubMed1985

The ability of a submaximal exercise test to predict maximal exercise capacity in patients with heart failure.

We investigated the ability of a submaximal exercise test to predict the maximal aerobic potential and hence exercise capacity of patients with chronic heart failure. Heart rate, oxygen consumption and carbon dioxide production were measured continuously during treadmill exercise in 29 patients with chronic heart failure (NYHA Class II-III). The anaerobic threshold was determined as the oxygen consumption at which carbon dioxide production increased non-linearly relative to oxygen consumption. Maximal oxygen consumption could not be predicted from the heart rate response to submaximal exercise. Oxygen consumption at the anaerobic threshold (28 patients) and at a respiratory quotient of 1 (23 patients) did predict maximal oxygen consumption (r = 0.93, r = 0.88, respectively). Measurement of oxygen consumption during submaximal exercise can be used to assess maximal exercise capacity in patients with heart failure.

Adult↗
PubMed1998

Sensitivity and specificity of asymmetric recall on WADA test to predict outcome after temporal lobectomy.

Some reports suggest that the intracarotid amobarbital test (IAT) is useful for predicting good seizure outcome after temporal lobectomy. The sensitivity, specificity, and predictive value of the IAT in this condition has not been previously studied. We designed this study to establish the value of memory recall asymmetry on the IAT as a predictor of outcome after temporal lobectomy. We studied memory recall on the IAT in 108 consecutive patients with intractable epilepsy who underwent presurgical evaluation for temporal lobectomy and had at least 1 year follow up after surgery. At a level of 30% asymmetry of recall, specificity for favorable outcome (Engel Class I and II) was 100% (95% confidence interval [CI], 85 to 100), sensitivity 51% (95% CI, 40 to 62), positive predictive value 100% (95% CI, 92 to 100), and negative predictive value 34% (95% CI, 23 to 47). At the same level of asymmetry, specificity for seizure-free outcome (Engel Class I) was 88% (95% CI, 68-95), sensitivity 37% (95% CI, 40 to 64), positive predictive value 87% (95% CI, 71 to 96), and negative predictive value 38% (95% CI, 27 to 50). Asymmetric recall on the IAT is highly specific but not very sensitive in predicting outcome after temporal lobectomy.

Adult↗