[An acute pharmacological test in predicting the efficacy of hypotensive therapy].
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Adult↗
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A rapid MMP-8 bedside test for the detection of intra-amniotic inflammation identifies patients at risk for imminent preterm delivery.
OBJECTIVE: Matrix metalloproteinase-8 (MMP-8) is an enzyme that is released during neutrophil activation. MMP-8 amniotic fluid concentrations are elevated not only in patients with intra-amniotic infection, but also in patients with negative amniotic fluid cultures who deliver preterm neonates. The objective of this study was to determine whether the results of a rapid MMP-8 bedside test predict imminent preterm delivery. This test can be performed in 15 minutes and without laboratory equipment. STUDY DESIGN: Amniotic fluid was retrieved from 331 patients admitted with increased preterm uterine contractions and intact membranes who met the inclusion criteria. Amniotic fluid was processed for microbial cultures, Gram stain, glucose concentration, and white blood cell count. Amniotic fluid samples were stored, and the MMP-8 rapid test was performed after delivery. End points included spontaneous preterm delivery within 48 hours, 7 days, and 14 days. Diagnostic indices, predictive values, and likelihood ratios were calculated. RESULTS: The prevalence of spontaneous preterm delivery within 48 hours, 7 days, and 14 days was 11.6% (38/327), 20.2% (66/327), and 24.5% (80/327), respectively (4 patients with augmentation of labor were excluded). A positive MMP-8 rapid test had a positive predictive value of 70% (23/33) for the identification of patients who delivered spontaneously within 48 hours, and 94% (31/33) for patients who were delivered within 7 days and 14 days (likelihood ratios: 17.5 [95% CI, 9-33.9], 61.3 [95% CI, 15.1-250], and 50 [95% CI, 12-196], respectively). CONCLUSION: The MMP-8 rapid test can identify patients at risk for preterm delivery within 7 days and 14 days. Moreover, a positive MMP-8 rapid test result can identify patients with intra-amniotic infection/inflammation with a high sensitivity and specificity. This rapid test will give clinicians a fast and accurate assessment of the inflammatory status of the amniotic cavity and allow for better identification of patients at risk for impending preterm delivery.
Adult↗
The role of serum ferritin in the diagnosis of iron deficiency anaemia in patients with liver cirrhosis.
OBJECTIVES: To determine the diagnostic values of serum ferritin and other conventional laboratory tests in the diagnosis of iron deficiency anaemia in patients with liver cirrhosis. DESIGN: Cross-sectional study for diagnostic tests. SETTING: University hospital. SUBJECTS: Seventy-two consecutive patients with liver cirrhosis in whom the haemoglobin level was less than 13.0 g dL(-1) for men and 12.0 g dL(-1) for women. The diagnosis of liver cirrhosis was based on characteristic clinical and hepatic ultrasonographic findings. MAIN OUTCOME MEASURES: By using absence of bone marrow iron as the standard criterion, the diagnostic powers of mean corpuscular volume, transferrin saturation, serum ferritin and the presence of hypochromic red cells in the diagnosis of iron deficiency were compared by analysing the likelihood ratios, the area under the receiver operating curves (ROC) and the stepwise logistic regression associated with each test. RESULTS: Twenty-nine patients (40.3%) demonstrated no stainable iron in the bone marrow. The likelihood ratios, the area under the ROC and the stepwise logistic regression indicated that serum ferritin was the most powerful test predictive of iron deficiency. Other tests added little further diagnostic values. The likelihood ratios associated with the serum ferritin levels were as follows: <50 microg L(-1), 22.3; 51-200 microg L(-1), 1.5-1.8; 201-400 microg L(-1), 1.0; >400 microg L(-1), <1. These results indicate that serum ferritin level <50 microg L(-1) depict a very high probability of iron deficiency anaemia (0.83-0.99) irrespective of the patient's pre-test probability. CONCLUSION: Serum ferritin is the most powerful noninvasive test for the diagnosis of iron deficiency anaemia in patients with liver cirrhosis. It should be the primary test of choice in patients suspected of having the disease. When the level was less than 50 microg L(-1), iron supplement may be prescribed without necessitating bone marrow aspiration.
Adult↗
[Prolactin and cancer of the breast. II. Prediction of the response to hormone treatment. The Minton test].
The prediction of the response to endocrine therapy in breast cancer is important. Although the estrogen receptor assay is a fundamental procedure to know hormone dependency in breast cancer, the changes produced in the serum prolactin level after administering L-dopa is a simple and reproducible method that can be used as alternative predictive test in some cases. This work shows that a 65 per 100 decrease or more in the L-dopa induced prolactin level prognosticates the existence of a hormone responsive tumor.
Breast Neoplasms↗
Fetal umbilical artery Doppler response to graded maternal aerobic exercise and subsequent maternal mean arterial blood pressure: predictive value for pregnancy-induced hypertension.
Predictive tests for the identification of women at high risk of the development of preeclampsia are critical to allow the most appropriate preventive measures. Preeclampsia is a vasospastic condition of pregnancy characterized by early and enhanced vascular reactivity to endogenous pressor agents. Exercise tolerance testing with cycle ergometry to induce hemodynamic response measured with duplex Doppler A/B ratio of the umbilical artery could unmask latent vascular pressor hypersensitivity. Our prospective cohort study was designed to test the efficacy of the American College of Obstetricians and Gynecologists exercise in pregnancy guidelines for the low-risk athletic, physically active, or sedentary patient. The pattern of fetal response to material exercise testing at 28 weeks' gestation was compared with subsequent maternal mean arterial blood pressure and the development of pregnancy-induced hypertension and preeclampsia. Doppler A/B ratio during the recovery period was assessed as below baseline (18) or elevated above resting baseline values (12). Third-trimester blood pressure pattern was assessed to be elevated in 11 patients, 10 of whom had elevated recovery A/B ratios. The Fisher exact test results were (p = 0.00002) positive predictive value, 83%; negative predictive value, 94%; sensitivity, 91%; and specificity, 89%. Preeclampsia developed in four patients; all had elevated recovery A/B ratios. Fisher exact test results were (p = 0.01806) positive predictive value, 33%; negative predictive value, 100%; sensitivity, 100%; and specificity, 69%.
Blood Pressure↗
Accuracy of ovarian reserve tests.
Several tests predict ovarian reserve in women undergoing assisted reproductive technologies. However, the accuracy of these tests in assessing the number of the remaining follicles within the ovary (ovarian reserve) has not been previously validated. The aim of this study was to assess the accuracy of ovarian reserve tests, namely basal and clomiphene-stimulated follicle stimulating hormone (FSH) concentrations and gonadotrophin-releasing hormone (GnRH) agonist stimulation test in predicting the number of the follicles within the ovaries. The ovaries of 22 parous women over 35 years of age who underwent oophorectomy were examined histologically for follicle number. Early follicular phase serum FSH, clomiphene citrate challenge tests (CCCT) and GnRH agonist stimulation test (GAST) were performed in the menstrual cycle prior to the surgery. The predictive value of these tests was then assessed. A positive correlation was detected between basal serum oestradiol concentrations and follicles per unit tissue but no significant correlation was detected between basal and clomiphene-stimulated FSH and follicles per unit tissue. The receiver operator characteristic curves indicated that the clomiphene citrate challenge test was the most accurate of the three tests assessed. In conclusion, none of the tests in this study accurately reflects ovarian reserve.
Adult↗
Comparison of dobutamine ECG stress test with predischarge exercise test after acute myocardial infarction.
Exercise testing after acute myocardial infarction is commonly used, but in recent years alternative methods have been proposed. Standard exercise testing was compared with dobutamine electrocardiographic (ECG) stress testing in 100 patients after an acute initial myocardial infarction. Dobutamine ECG stress testing was performed in a standard manner at 5 +/- 1 days after the infarction and exercise testing was performed a mean of 10 +/- 2 days following the event. Agreement between both tests was observed in 91 cases (91%), P < .001, Fisher test kappa value, 0.79). The dobutamine test predicted the result of the exercise test with a sensitivity of 100% (95% confidence interval, 87-100) and a specificity of 88% (95% confidence interval 77-93) for a positive predictive value of 75% (95% confidence interval, 62-97) and a negative predictive value of 100% (95% confidence interval, 91-100). Dobutamine ECG stress testing is concluded to be an objective and reliable procedure, which accurately predicts the results of standard exercise testing. It is inexpensive, easy to perform, and although not yet confirmed, could be particularly useful in patients who cannot perform exercise.
Aged↗
The relationship between neuropsychological test performance, social functioning, and instrumental activities of daily living in a sample of rural older adults.
This study examined the relationship between neuropsychological functioning, activities of daily living, and social interaction in a biracial sample of 133 rural community-dwelling participants with fewer than 10 years of education, who were tested twice over 4 years as part of a normative study. Neuropsychological tests predicted self-reported IADL and social functioning at Time 1 after accounting for age, education, health, depression, and gender. Physical health and the Initiation and Perseveration subscale of the Mattis Dementia Rating Scale best predicted instrumental activities of daily living. Social functioning was best predicted by gender and delayed memory recall from the Fuld Object Memory Evaluation. Functional independence and social activities declined slightly over time for all participants, but those whose neuropsychological test scores declined significantly at Time 2 reported less independence and fewer social activities at Time 1 than those participants whose cognition remained stable. Ecological and concurrent validity of self-report measures of functional status and neuropsychological testing in predicting cognitive decline are discussed.
Activities of Daily Living↗
Moral concerns of different types of patients in clinical BRCA1/2 gene mutation testing.
PURPOSE: Implementing predictive genetic testing for a severe and common chronic disease such as breast cancer may raise unique ethical problems. Here we report on moral concerns experienced by patients in the setting of genetic counseling based on BRCA1/2 gene testing. PATIENTS AND METHODS: Patients were members of breast or breast/ovarian cancer families in a consecutive series of 100 families who received counseling at a familial cancer clinic. The patients' moral concerns were identified using the grounded theory approach in the qualitative analysis of verbal transcripts of 45 counseling sessions. Included were sessions with patients who had breast and ovarian cancer, as well as their male and female relatives, before and after the specific BRCA1/2 gene mutation was identified in the family, and before and after those who opted for mutation analysis were informed of their carrier status. RESULTS: There is an association of BRCA1/2 gene mutation carrier status and specific topics of moral concern. The moral preoccupations of patients with breast and ovarian cancer (probable carriers) related to their being instrumental in the detection of the specific mutation segregating in the family. The preoccupations of possible carriers concerned their own offspring. Individuals who tested positive (proven carriers) were concerned with issues of confidentiality. Patients who tested negative (proven noncarriers) were concerned with helping siblings and other relatives. CONCLUSION: Knowledge of the moral concerns of subjects in the study sample may help health care providers be aware of the moral concerns of their own patients. This report may also contribute to the debate on predictive testing for familial adult-onset diseases from the patient's perspective.
BRCA2 Protein↗
Comparison of dobutamine electrocardiographic stress test and exercise test in two different groups of patients with unstable angina.
Exercise testing is a well known means of evaluating patients with unstable angina, but in recent years, alternative methods have been proposed. We prospectively compared standard exercise testing with dobutamine electrocardiographic stress testing for patients who were admitted with a diagnosis of unstable angina. A total of 43 patients were studied, divided into two different groups, according to the presence (group A n = 26) or absence (group B n = 17) of a previous history of coronary artery disease and/or electrocardiographic changes compatible with ischemia on admission. Dobutamine electrocardiographic stress testing was performed in a standard manner at 3 +/- 1 days after admission in group A and at 16 +/- 8 hours after admission in group B. Exercise testing was performed, on average 5 +/- 1 days following the event in group A and 2 days after admission in group B. Agreement between both tests was observed in 39 (91%) cases, Kappa value: 0.81. The dobutamine test predicted the result of the exercise test with a sensitivity of 79% (95% CI 54-90), and a specificity of 100% (95% CI 86-100), with a positive predictive value of 100% and a negative predictive value of 86%. It can be concluded that dobutamine electrocardiographic stress testing is an objective and reliable procedure that accurately predicts the results of standard exercise testing in patients with a diagnosis of unstable angina. If this result were confirmed with a greater number of patients, it would be a good option for definitive diagnosis and risk stratification, in addition to being inexpensive and easy to perform. It can also be particularly useful for patients who cannot perform exercise.
Adult↗
Predictive value of the "clue cells" investigation and the amine volatilization test in vaginal infections caused by Gardnerella vaginalis.
Although still controversial, an etiologic role of Gardnerella vaginalis is imputed in vaginitis. Besides isolation of the organism by culture, two alternative diagnostic procedures have been claimed to be useful: the investigation of "clue cells" in clinical specimens and the amine volatilization test or fishy odor perception in genital secretions. Herein we report on the findings of the simultaneous use of G. vaginalis isolation, the clue cell test and amine volatilization perception in specimens from 1,263 consecutive female patients referred to our clinic. Our results show that the simultaneous use of both alternative tests is very useful as a screening procedure. A negative result of both tests predicts a negative culture result in 99% of the cases. However, a positive result of either or both should be considered as an indication to proceed to culture and not as diagnostic of infection.
Adolescent↗
Development of predictive selection and placement tests for personnel evaluation.
There are a number of similar approaches for developing useful occupational selection and placement tests. The primary concern is that the tests be predictive of occupational requirements. This paper discusses an approach that emphasises the predictive criterion and uses a case study involving the development of occupational physical selection standards to illustrate the salient points. The following steps are discussed: (1) identification of the occupational requirements; (2) identification of the candidate tests; (3) establishment of predictive relationships between tasks representing the occupational requirements and the candidate tests; (4) determination of useful performance standards on a selected test; and (5) validation of the proposed performance standards. For this case study, it is concluded that performance standards on a lifting test could be developed for predicting the performance of two lifting tasks, using this approach.
Journal Article↗
Cigarette smoking in a student sample: neurocognitive and clinical correlates.
Why do adolescents begin to smoke in the face of profound health risks and aggressive antismoking campaigns? The present study tested predictions based on two theoretical models of tobacco use in young adults: (1) the self-medication model; and (2) the orbitofrontal/disinhibition model. Investigators speculated that a significant number of smokers were self-medicating since nicotine possesses mood-elevating and hedonic properties. The self-medication model predicts that smokers will demonstrate increased rates of psychopathology relative to nonsmokers. Similarly, researchers have suggested that individuals with attention-deficit/hyperactivity disorder (ADHD) employ nicotine to enhance cognitive function. The ADHD/self-medication model predicts that smokers will perform poorly on tests of executive function and report a greater number of ADHD symptoms. A considerable body of research indicates that tobacco use is associated with several related personality traits including extraversion, impulsivity, risk taking, sensation seeking, novelty seeking, and antisocial personality features. Antisocial behavior and related personality traits as well as tobacco use may reflect, in part, a failure to effectively employ reward and punishment cues to guide behavior. This failure may reflect orbitofrontal dysfunction. The orbitofrontal/disinhibition model predicts that smokers will perform poorly on neurocognitive tasks considered sensitive to orbitofrontal dysfunction and will obtain significantly higher scores on measures of behavioral disinhibition and antisocial personality relative to nonsmokers. To test these predictions, we administered a battery of neuropsychological tests, clinical scales, and personality questionnaires to university student smokers and nonsmokers. Results did not support the self-medication model or the ADHD/self-medication model; however, findings were consistent with the orbitofrontal/disinhibition model.
Adolescent↗
Development of a short test for accident proneness.
In developing the Accident Proneness Prediction Test to measure motor control skills related to safety aptitudes subjects were instructed to draw on a sheet of paper as many circles as possible within a limited amount of time. The responses were scored in terms of the speed and quality (irregularities) of the produced circles. Although 103 accident-prone drivers produced more circles than the 178 good drivers, the quality of performance of the accident-prone drivers was poorer than that of the good drivers. Based on this validity study, we proposed these predictive criteria for further testing of accident proneness.
Accident Proneness↗
Screening for the potential of a drug candidate to cause idiosyncratic drug reactions.
Toxicity testing has been ineffective in the prediction of drug candidates that will be associated with a relatively high incidence of idiosyncratic drug reactions (IDRs). Circumstantial evidence suggests the involvement of reactive metabolites in the aetiology of these reactions and this has prompted several companies to screen drug candidates for the formation of such compounds. Most drugs form at least one reactive metabolite. To develop efficient prediction methods, a better understanding of the basic mechanisms involved is essential. This review highlights the current mechanistic hypotheses of IDRs and discusses future directions in the development of better predictive tests.
Animals↗
Approaches to induce and elicit respiratory allergy: impact of route and intensity of exposure.
Although a number of test protocols have been developed to predict respiratory allergenic potential, none of these are widely applied or fully accepted. However, given the serious health problems caused by respiratory allergy and the ever-increasing stream of new chemicals into workplaces, early identification of chemical respiratory allergens is important. Inhalation exposure as well as skin application have been used in predictive tests to induce respiratory tract sensitisation. While there are good indications in laboratory animals and humans that skin exposure can act as a route for respiratory tract sensitisation and vice versa, less is known about the effect of the route on the type of allergy evoked and on dose-response relationships. Although, the responses were in general more vigorous after dermal sensitisation than after inhalation sensitisation, the nature of the immune responses seemed to be qualitatively comparable. As to the intensity of exposure, dose or concentration-response relationships have been observed both during respiratory sensitisation and challenge, suggesting that assessment of safe exposure levels is feasible. Finally, a correct distinction between respiratory allergens and non-sensitising airway irritants is needed for effective risk assessment and management.
Administration, Cutaneous↗
The relationship between self-reports of imagery and spatial ability.
A puzzling question arising from imagery research is why no relationship has been found between self-reports of imagery and performance on spatial tests thought to require the use of imagery. To investigate this, spatial ability, measured by performance on two spatial tests, was compared with performance on the Vividness of Visual Imagery Questionnaire (VVIQ; Marks, 1973) and a newly constructed imagery questionnaire. The choice of items and ratings for the new questionnaire was based on Kosslyn's (1980, 1994) theories of the imagery system. Ratings on the new questionnaire consistently correlated significantly with performance on the spatial tests, whereas ratings from the VVIQ did not. The new ratings captured more of the imagery process than ratings of vividness alone, but the largest change depended upon the type of item imagined. Ratings of items of the same type as used on the spatial tests predicted performance on the spatial tests, whereas vividness ratings of items recalled or constructed from long-term memory did not. Participants can successfully introspect on several different properties of their images, and their ratings do predict performance on tasks thought to require imagery. The large effect of item type raises questions about the predictive value of existing models of the imagery system especially in relation to the role of phenomenological properties of our images.
Adolescent↗
Anal and cervical abnormality in women--prediction by human papillomavirus tests.
A total of 151 women at risk of human immunodeficiency virus infection were investigated, to study the strength of the association between cervix and anus regarding the presence of HPV and cytological abnormality. An equal percentage of women had abnormal cervical (12.2%) and anal (12.1%) Papanicolaou smears. HPV measured by PCR was detected in 93.3% of cervical squamous intraepithelial lesions (SIL) compared to 49.1% of normal cervical cytologies, and in 100% of anal SIL and 67.4% of normal anal cytologies, respectively. After controlling for HPV-PCR status, immunodeficiency, as measured by a low CD4+ count and HIV positivity, increased the detection of cervical and to some extent anal squamous intraepithelial lesions (SIL). We evaluated how precisely an HPV test could predict cervical disease and found that the HPV-PCR test was slightly more sensitive than the HPV-hybrid capture (HC) test (PCR: 93.3% vs. HC: 88.9%), whereas the HC test was significantly more specific (83.6% vs. 50.9%), and with a much higher positive predictive value (43.2% vs. 20.6%). Similar results were obtained for anal SIL. HIV positivity increased sensitivity, lowered specificity and increased the positive predictive value of the tests. A diagnosis of cervical SIL was associated with a more than 3-fold increased risk of a simultaneous abnormal anal smear (p < 0.05). In conclusion, cervical and anal disease were significantly associated and almost exclusively seen in the presence of HPV. Immunodeficiency and HIV positivity increased the risk of disease in HPV-positive subjects. Hybrid capture, which requires a higher viral load than PCR to detect HPV, was clearly superior in predicting cervical and anal disease. Altogether, these findings suggest that a high level of HPV infection may be important for the development of SIL in the population studied.
Adult↗