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Evaluating the Modified American Academy of Pediatrics screening algorithm for Critical Congenital Heart Disease

AMERICAN JOURNAL OF PERINATOLOGY 2025年第5期42卷 674-682页

作者： Hoff, Hannah Quary, Sharon Keesari, Rohali Oster, Matthew E. Baylor Coll Med Dept Internal Med Houston TX USA Northside Hosp Dept Pediat Atlanta GA USA Emory Univ Sch Med Dept Pediat Atlanta GA USA Childrens Healthcare Atlanta Dept Cardiol Atlanta GA USA

Objective In 2018, an expert panel recommended two key modifications to the most used algorithm for screening neonates for critical congenital heart disease (CCHD). Our aim was to evaluate the outcomes of the modified algorithm compared with those of the original algorithm in a real-world setting. Study Design We compared the performance characteristics of an original CCHD algorithm used to screen term neonates at a large hospital system between October 26, 2018, and October 15, 2020, and the recommended modified algorithm used between October 15, 2020, and June 30, 2022. We calculated sensitivity, specificity, false positive rate, proportion of false positives with non-CCHD illness, and error rates of test administration and interpretation for each algorithm. Results Sensitivity was not significantly different between the modified algorithm compared with the original algorithm (40.00 vs. 12.50%, p >= 0.99), but specificity was lower (and hence false positive rate was higher) in the modified algorithm (99.91 vs. 99.98%, p < 0.001). Despite a higher false positive rate in the modified algorithm, the proportion of false positives with significant non-CCHD illness was similar (36.47 vs. 28.57%, p >= 0.99), a finding that translated to an increase in the number of cases of significant non-CCHD illness detected (11 cases out of 32,178 screens vs. 2 cases out of 32,984 screens). Error rates of test administration and interpretation were similar between the two algorithms. Conclusion In this limited study, the modified algorithm for CCHD screening using pulse oximetry had a higher false positive rate than that of the original American Academy of Pediatrics algorithm. However, this higher rate led to an increased overall number of cases detected of significant non-CCHD illness. Key Points Experts recommend two changes to the American Academy of Pediatrics-endorsed CCHD screen. This study evaluates the new algorithm for screening. The new algorithm detects at least as many c

关键词： critical congenital heart disease pulse oximetry screening algorithm

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Clinical Validation of a Primary Antibody Deficiency screening algorithm for Primary Care

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JOURNAL OF CLINICAL IMMUNOLOGY 2023年第8期43卷 2022-2032页

作者： Messelink, Marianne A. Welsing, Paco M. J. Devercelli, Giovanna Marsden, Jan Willem N. Leavis, Helen L. Univ Med Ctr Utrecht Dept Rheumatol & Clin Immunol Utrecht Netherlands Takeda Dev Ctr Amer Deerfield IL USA

Purpose The diagnostic delay of primary antibody deficiencies (PADs) is associated with increased morbidity, mortality, and healthcare costs. Therefore, a screening algorithm was previously developed for the early detection of patients at risk of PAD in primary care. We aimed to clinically validate and optimize the PAD screening algorithm by applying it to a primary care database in the Netherlands. Methods The algorithm was applied to a data set of 61,172 electronic health records (EHRs). Four hundred high-scoring EHRs were screened for exclusion criteria, and remaining patients were invited for serum immunoglobulin analysis and referred if clinically necessary. Results Of the 104 patients eligible for inclusion, 16 were referred by their general practitioner for suspected PAD, of whom 10 had a PAD diagnosis. In patients selected by the screening algorithm and included for laboratory analysis, prevalence of PAD was 1:10 versus 1:1700-1:25,000 in the general population. To optimize efficiency of the screening process, we refitted the algorithm with the subset of high-risk patients, which improved the area under the curve-receiver operating characteristics curve value to 0.80 (95% confidence interval 0.63-0.97). We propose a two-step screening process, first applying the original algorithm to distinguish high-risk from low-risk patients, then applying the optimized algorithm to select high-risk patients for serum immunoglobulin analysis. Conclusion Using the screening algorithm, we were able to identify 10 new PAD patients from a primary care population, thus reducing diagnostic delay. Future studies should address further validation in other populations and full cost-effectiveness analyses.

关键词： Primary antibody deficiencies primary care database diagnostic delay screening algorithm validation study

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A conservative screening algorithm to determine candidacy for robotic mitral valve surgery

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JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022年第4期164卷 1080-1087页

作者： Chemtob, Raphaelle A. Wierup, Per Mick, Stephanie L. Javorski, Michael J. Burns, Daniel J. P. Blackstone, Eugene H. Svensson, Lars G. Gillinov, A. Marc Cleveland Clin Dept Thorac & Cardiovasc Surg Heart Vasc & Thorac Inst Cleveland OH 44195 USA Cleveland Clin Lerner Res Inst Quantitat Hlth Sci Cleveland OH 44195 USA

Objective: Patient selection for robotically assisted mitral valve repair remains controversial. We assessed outcomes of a conservative screening algorithm developed to select patients with degenerative mitral valve disease for robotic surgery. Methods: From January 2014 to January 2019, a screening algorithm that included transthoracic echocardiography and computed tomography scanning was rigorously applied by 3 surgeons to assess candidacy of 1000 consecutive patients with isolated degenerative mitral valve disease (age 58 +/- 11 years, 67% male) for robotic surgery. screening results and hospital outcomes of those selected for robotic versus sternotomy approaches were compared. Results: With application of the screening algorithm, 605 patients were selected for robotic surgery. Common reasons for sternotomy (n = 395) were aortoiliac atherosclerosis (n = 74/292, 25%), femoral artery diameter <7 mm (n = 60/292, 20%), mitral annular calcification (n = 83/390, 21%), aortic regurgitation (n = 100/391, 26%), and reduced left ventricular function (n = 126/391, 32%). Mitral valve repair was accomplished in 996. Compared with sternotomy, patients undergoing robotic surgery had less new-onset atrial fibrillation (n = 144/582, 25% vs n = 125/373, 34%;P = .002), fewer red blood cell transfusions (n = 61/601, 10% vs 69/395, 17%;P < .001), and shorter hospital stay (5.2 +/- 2.9 days vs 5.9 +/- 2.1 days;P < .001). No hospital deaths occurred, and occurrence of postoperative stroke in the robotic (n = 3/605, 0.50%) and sternotomy (n = 4/395,1.0%;P = .3) groups was similar. Conclusions: This conservative screening algorithm qualified 60% of patients with isolated degenerative mitral valve disease for robotic surgery. Outcomes were comparable with those obtained with sternotomy, validating this as an approach to select patients for robotic mitral valve surgery.

关键词： mitral valve repair mitral valve replacement robotic surgery minimally invasive screening algorithm

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Efficient screening algorithm of selenium resistant mutants of arabidopsis thaliana

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JOURNAL OF DISCRETE MATHEMATICAL SCIENCES & CRYPTOGRAPHY 2018年第2期21卷 345-349页

作者： Li, Na Wu, Xiao Zhang, Xingtao Zhao, Liang Suzhou Univ Sch Biol & Food Engn Suzhou 234000 Peoples R China

Using the current method to screen and analyze the resistant mutant of Arabidopsis thaliana, there is a problem that the antioxidant capacity is poor. In this paper, an efficient algorithm for screening resistant mutants of Arabidopsis thaliana in vitro is proposed. in this study, the Arabidopsis thaliana selenium-resistant mutants are extracted and by combining the in vitro extraction, the in vitro screening method is used to screen the Selenium-resistant mutants of Arabidopsis thaliana, so as to realize the in vitro screening method research and analysis for Arabidopsis thaliana. The experimental results show that the algorithm can effectively improve the selenium resistant of Arabidopsis thaliana.

关键词： Arabidipsis thaliana Selenium resistant screening algorithm

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Data management of a pneumonia screening algorithm in Veterans Affairs Medical Centers

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Journal of Medical Systems 1996年第6期20卷 395-401页

作者： Reed III, James E. Baumann, Margaret Petzel, Robert Weeks Jr., Harry S. West Virginia Medical Institute Charleston WV 25304 United States VA Medical Center West Side Chicago IL 60680 United States University of Illinois College of Medicine Chicago IL 60616 United States VA Medical Center Minneapolis MN 55417 United States

The Veterans Affairs External Peer Review Program (EPRP) reviews patient care episodes in Veterans Affairs Medical Centers (VAMCs) across the United States. This review process uses screening algorithms, followed by peer review, to identify deviations in the care provided by the VAMCs. A schematic model of the case selection, data acquisition at each VAMC, data flow between the VAMCs and the West Virginia Medical Institute (WVMI), data processing at WVMI, and the peer review process are given. A model pneumonia clinical practice guideline was generated by an expert panel of physicians external to the VAMCs. This guideline identifies benchmark criteria that reflect the clinical standards for diagnosing and treating hospitalized pneumonia patients. A screening algorithm was then designed, tested, and implemented to identify deviations in the quality of care delivered by VAMCs to hospitalized pneumonia patients.

关键词： and database management Clinical Practice Guideline peer review screening algorithm

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Effects of Image Compression and Degradation on an Automatic Diabetic Retinopathy screening algorithm

Effects of Image Compression and Degradation on an Automatic...

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Conference on Medical Imaging 2010 - Computer-Aided Diagnosis

作者： Agurto, C. Barriga, S. Murray, V. Pattichis, M. Soliz, P. VisionQuest Biomed Albuquerque NM 87106 USA Univ New Mexico Dept Elect & Comp Engn Albuquerque NM 87131 USA Univ Iowa Dept Ophthalmol & Visual Sci Iowa City IA 52242 USA

ISBN: (纸本)9780819480255

Diabetic retinopathy (DR) is one of the leading causes of blindness among adult Americans. Automatic methods for detection of the disease have been developed in recent years, most of them addressing the segmentation of bright and red lesions. In this paper we present an automatic DR screening system that does approach the problem through the segmentation of features. The algorithm determines non-diseased retinal images from those with pathology based on textural features obtained using multiscale Amplitude Modulation-Frequency Modulation (AM-FM) decompositions. The decomposition is represented as features that are the inputs to a classifier. The algorithm achieves 0.88 area under the ROC curve (AROC) for a set of 280 images from the MESSIDOR database. The algorithm is then used to analyze the effects of image compression and degradation, which will be present in most actual clinical or screening environments. Results show that the algorithm is insensitive to illumination variations, but high rates of compression and large blurring effects degrade its performance.

关键词： Diabetic retinopathy image compression image degradation screening algorithm

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Prospective evaluation of a screening algorithm for carbapenemase-producing Enterobacteriaceae

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JOURNAL OF CLINICAL LABORATORY ANALYSIS 2019年第3期33卷 e22706-e22706页

作者： Choquet, Morgane Guiheneuf, Raphael Castelain, Sandrine Pluquet, Emilie Decroix, Veronique Amiens Univ Hosp Dept Bacteriol Amiens France Jules Verne Univ Picardie Microbiol Res Unit AGIR EA4294 Amiens France

Background Carbapenemase-producing Enterobacteriaceae (CPE) have become a major public health issue. The objective of the present study was to prospectively assess the analytical performance of a CPE detection algorithm based on phenotypic tests (the screening test) and MALDI-ToF hydrolysis (the confirmatory test). Methods Over a 6-month period and based on a disk diffusion method, 74 carbapenem-resistant strains were included in this study. Results Of the collected isolates, 54 turned out to be negative after phenotypic tests. Hence, 20 strains (including all of the CPEs) were checked with the confirmation test. Seven strains were positive. After molecular biology assessments in a reference center, three of the seven were found to be false positives. The algorithm had a negative predictive value and a sensitivity of 100%, a specificity of 77%, and a positive predictive value of 20%. Conclusion The algorithm has a 24-hour turnaround time and helps to avoid using expensive molecular biology tests;we consider that it can be used on a routine basis for screening clinical strains.

关键词： carbapenem carbapenemase-producing Enterobacteriaceae prospective resistance screening algorithm

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Sensitivity of a Simple Noninvasive screening algorithm for Chronic Thromboembolic Pulmonary Hypertension after Acute Pulmonary Embolism

TH open : companion journal to thrombosis and haemostasis

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TH open : companion journal to thrombosis and haemostasis 2018年第1期2卷 e89-e95页

作者： Yvonne M Ende-Verhaar Dieuwertje Ruigrok Harm Jan Bogaard Menno V Huisman Lilian J Meijboom Anton Vonk Noordegraaf Frederikus A Klok Department of Thrombosis and Hemostasis Leiden University Medical Center Leiden The Netherlands. Department of Pulmonology VU University Medical Center Amsterdam The Netherlands. Department of Radiology and Nuclear Medicine VU University Medical Center Amsterdam The Netherlands.

Recently, we constructed a noninvasive screening algorithm aiming at earlier chronic thromboembolic pulmonary hypertension (CTEPH) detection after acute pulmonary embolism (PE), consisting of a prediction score and combined electrocardiography (ECG)/N-terminal pro-brain natriuretic peptide (NT-proBNP) assessment. The aim of this study was to confirm the algorithm's sensitivity for CTEPH detection and to evaluate the reproducibility of its individual items. Two independent researchers calculated the prediction score in 54 consecutive patients with a history of acute PE and proven CTEPH based on clinical characteristics at PE diagnosis, and evaluated the ECG and NT-proBNP level assessed at the moment of CTEPH diagnosis. Interobserver agreement for the assessment of the prediction score, right-to-left ventricle (RV/LV) ratio measurement on computed tomography pulmonary angiography, as well as ECG reading was evaluated by calculating Cohen's kappa statistics. Median time between PE diagnosis and presentation with CTEPH was 9 months (interquartile range: 5-15). The sensitivity of the algorithm was found to be 91% (95% confidence interval [CI]: 79-97%), indicating that 27 of 30 cases of CTEPH would have been detected when applying the screening algorithm to 1,000 random PE survivors with a 3% CTEPH incidence (projected negative predictive value: 99.7%; 95% CI: 99.1-99.9%). The interobserver agreement for calculating the prediction score, RV/LV ratio measurement, and ECG reading was excellent with a kappa of 0.96, 0.95, and 0.89, respectively. The algorithm had a high sensitivity of 91% and was highly reproducible. Prospective validation of the algorithm in consecutive PE patients is required before it can be used in clinical practice.

关键词： CTEPH pulmonary embolism reproducibility screening algorithm sensitivity

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The first validated criteria for effective screening and a new simplified method for α-globin gene sequencing for diagnosis of uncommon α-globin mutations

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INTERNATIONAL JOURNAL OF HEMATOLOGY 2017年第6期105卷 819-827页

作者： Uaprasert, Noppacharn Settapiboon, Rung Amornsiriwat, Supaporn Sutcharitchan, Pranee Rojnuckarin, Ponlapat Chulalongkorn Univ Dept Med Fac Med Div Hematol Bangkok 10330 Thailand Thai Red Cross Soc King Chulalongkorn Mem Hosp Bangkok 10330 Thailand

No well-defined phenotypes that distinguish between unknown alpha- and beta-globin mutations have been reported to date. Direct DNA sequencing of alpha-globin genes can be technically challenging, as alpha 1- and alpha 2-globin genes are nearly indistinguishable. To detect hemoglobin variants (HbXs) on Hb analysis, the entire beta- and alpha-globin genes were directly sequenced using a newly developed sequencing protocol for alpha-globin genes. An algorithm to distinguish between alpha- and beta-HbXs was constructed and subsequently validated in the independent validation group. Distinctive characteristics that can distinguish 39 alpha-HbXs from 24 beta-HbXs were the presence of unidentifiable variants of HbA(2) and/or HbX of < 37% on isoelectric focusing and < 31% on high-performance liquid chromatography. Another set of 67 HbXs was employed to validate our algorithm. This accurately predicted 33 alpha-HbXs with 100% sensitivity and 97.1% specificity. Our sequencing protocol for alpha-globin genes was able to identify 11 rare mutations among all exons of both alpha-globin genes from 72 subjects. Six of these variants were first discovered in Thais. This is the first well-characterized algorithm for distinguishing unknown Hb variants in a large cohort. Our validated criteria and DNA sequencing procedure are highly efficient for molecular characterization of rare Hb mutations.

关键词： screening algorithm DNA sequencing alpha-Hemoglobin variants Validation

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The serological screening of deceased tissue donors within the English Blood Service for infectious agents - a review of current outcomes and a more effective strategy for the future

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VOX SANGUINIS 2010年第3期98卷 e193-e200页

作者： Kitchen, A. D. Gillan, H. L. NHS Blood & Transplant Natl Blood Serv NTMRL London NW9 5BG England NHS Blood & Transplant Tissue Serv Liverpool Merseyside England

Background and Objectives The overall effectiveness of the NHSBT screening programme for infectious agents in deceased tissue donors is examined and evaluated in terms of current outcomes and how to improve upon these outcomes. Materials and Methods The screening results and any subsequent confirmatory results from a total of 1659 samples from NHSBT deceased donors referred to NTMRL for screening for infectious agents were included in the analysis. Results Overall 1566/1659 (94 center dot 4%) of the samples were screen negative. A total of 93 were repeat reactive on screening for one or more of the mandatory markers screened for, of which only 12 (13%) were subsequently confirmed to be positive on confirmatory testing. The majority of the repeat reactive samples were demonstrating non-specific reactivity with the screening assays in use. Conclusion Overall, the NHSBT screening programme for infectious agents in deceased tissue donors is very effective with a relatively low overall loss of donors because of non-specific reactivity. However, unnecessary loss of tissue products is not acceptable, and although this programme compares favourably with the outcomes of other such programmes, the confirmatory results obtained demonstrate both the need and the potential for improving the outcomes. This is particularly important as one donor may donate more than one product, and can be achieved very easily with a change to the screening algorithm followed, using the confirmatory data obtained to support and validate this change. Contents Summary Critical analysis of the NHSBT screening programme for infectious agents in deceased tissue donors and a strategy involving the design and use of a different screening algorithm to improve these outcomes.

关键词： deceased tissue donor non-specific reactivity screening algorithm serological screening tissue product

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