Background: In 2017, the American Academy of Pediatrics (AAP) updated clinical practice guideline... more Background: In 2017, the American Academy of Pediatrics (AAP) updated clinical practice guidelines for the diagnosis and management of hypertension in children. The present study aimed to assess the prevalence of hypertension in Iranian children based on the latest guidelines. Methods: Data on 7301 student participants (3589 boys and 3712 girls) aged between 7-12 yr were assessed. The data were extracted from the fifth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN V) school-based study conducted in the 30 provinces of Iran in 2015. Blood pressure (BP) was classified as normal, elevated BP, and stage 1 and 2 hypertension using weighted analysis and the 2017 AAP guidelines. All analyses were performed in STATA 14.0 statistical software, with findings presented in terms of prevalence. Results: The overall prevalence of high BP in Iranian children was 14.7%. In addition, 15.1% of boys had high BP, with 9.4% and 1.7% of them with stage 1 and 2 hypertension, respectively. Moreover, 14.3% of girls had high BP, of which 10% had stage 1 and 1.3% with stage 2 hypertension. For elevated hypertension, it was observed in 4% of boys and 3% of girls. Conclusion: Using the 2017 AAP guidelines demonstrated a higher prevalence of hypertension in children (14.7%) in Iran. The prevalence of hypertension in boys was slightly higher compared to girls.
Objective: Determining the exact underlying etiology of loss of consciousness (LOC) can become a ... more Objective: Determining the exact underlying etiology of loss of consciousness (LOC) can become a real challenge for physicians due to the broadness of differential diagnoses. The current study aimed to assess the accuracy of a commercially available strip for urine drug screening, in patients presenting with LOC. Methods: One hundred fifty patients with LOC were enrolled in the current cross-sectional study. The diagnostic accuracy of a multidrug urinary strip rapid test was evaluated in comparison to blood analysis as the reference test, and the screening performance characteristics of the rapid test for each substance were estimated. Results: The average age of patients was 46.21±18.59 years (72.67% male). The most frequent false positive results of the test were related to Benzodiazepine (21.5%), Methamphetamine (7.5%), and Tramadol (5.4%), respectively. The screening performance characteristics of the test tape were the best in detection of Amitriptyline with 100.0% (95% CI: 30....
DOAJ (DOAJ: Directory of Open Access Journals), Aug 15, 2015
In the previous two parts of educational manuscript series in Emergency, we explained some screen... more In the previous two parts of educational manuscript series in Emergency, we explained some screening characteristics of diagnostic tests including accuracy, sensitivity, specificity, and positive and negative predictive values. In the 3rd part we aimed to explain positive and negative likelihood ratio (LR) as one of the most reliable performance measures of a diagnostic test. To better understand this characteristic of a test, it is first necessary to fully understand the concept of sensitivity and specificity. So we strongly advise you to review the 1st part of this series again. In short, the likelihood ratios are about the percentage of people with and without a disease but having the same test result. The prevalence of a disease can directly influence screening characteristics of a diagnostic test, especially its sensitivity and specificity. Trying to eliminate this effect, LR was developed. Pre-test probability of a disease multiplied by positive or negative LR can estimate post-test probability. Therefore, LR is the most important characteristic of a test to rule out or rule in a diagnosis. A positive likelihood ratio > 1 means higher probability of the disease to be present in a patient with a positive test. The further from 1, either higher or lower, the stronger the evidence to rule in or rule out the disease, respectively. It is obvious that tests with LR close to one are less practical. On the other hand, LR further from one will have more value for application in medicine. Usually tests with 0.1 < LR > 10 are considered suitable for implication in routine practice.
Introduction: Gathering information regarding the risk factors of mortality and disability due to... more Introduction: Gathering information regarding the risk factors of mortality and disability due to road traffic injuries can provide evidence for adopting effective interventions to reduce the burden of the injury. Therefore, the present study intends to identify the most important risk factors of road accident-related mortality in Iran by conducting a systematic review and meta-analysis. Methods: Search was done in English and Persian electronic databases, for articles published until the end of 2020. Cross-sectional, cohort and case-control studies were included. Risk factors were divided into age and sex, road related factors, exceeding speed limit, road user behaviors, vehicle related factors, weather condition, and light condition. Data were reported as adjusted odds ratio (OR) of death with 95% confidence interval (95% CI). Results: 20 studies were included (2,682,434 traffic accident victims and 23,272 deaths; mortality rate=1.28%). The risk of death in road traffic injuries i...
Introduction: The importance of evaluating performance indicators in the emergency department, a... more Introduction: The importance of evaluating performance indicators in the emergency department, as one of the most important departments of hospital, is obvious to everyone. Therefore, in this study we aimed to appraise the five performance indicators, approved by the ministry of health, in Shohadaye Tajrish hospital, Tehran, Iran. Methods: In a descriptive cross-sectional study based on the profiles of all the patients admitted to the emergency department, performance indicators in the emergency department were evaluated. The study was divided into 2 parts about the establishment of emergency medicine system and training the medical staff: the first 6 months of 1392 and the second. Then these 2 periods were compared using Mann-Whitney U test while P< 0.05 was considered as the level of significance. Results: Of the studied indicators, mean triage time was 6.04 minutes in the first 6 months which was reduced to 1.5 minutes in the second 6 months (p=0.016). In addition, the pe...
Background and Aim: Homelessness is a social problem with various contributory factors. This unde... more Background and Aim: Homelessness is a social problem with various contributory factors. This undesirable phenomenon involves various sections of civil and law enforcement in the community. The aim of this study was to determine the prevalence of disease and other complaints in homeless patients on admission to the Emergency Department of Imam Hossein Hospital, Tehran, Iran from 2012 to 2018. Methods: This retrospective descriptive study was carried out in Imam Hossein Hospital affiliated to Shahid Beheshti University of Medical Sciences. All homeless patients referring to emergency department of Imam Hossein Hospital from 2012 to 2018 were included in study. The data collection tool was a researcher-made checklist that included demographic features such as age and sex, and clinical conditions such as blood factors, hepatitis B and C status, HIV infection, blood culture, urine culture, abdominal fluid culture, complaints on admission, diagnosis and clinical outcome (discharge, operat...
در شماره 2، دوره 2، صفحات 105-107 مجله طب اورژانس ایران بعضی از ویژگی های تست های تشخیصی در قالب ... more در شماره 2، دوره 2، صفحات 105-107 مجله طب اورژانس ایران بعضی از ویژگی های تست های تشخیصی در قالب یک مقاله آموزشی با عنوان "پزشکی مبتنی بر شواهد؛ قسمت اول: تعریف و محاسبه ساده حساسیت، ویژگی و دقت یک تست" تعریف شده و نحوه محاسبه آنها بیان گردید. مقاله حاضر قصد دارد تا دو ویژگی دیگر تست های تشخیصی شامل ارزش اخباری مثبت و منفی را مورد توجه قرار دهد. ارزش اخباری مثبت و منفی به ترتیب عبارتند از موارد مثبت و منفی حقیقی گزارش شده توسط یک تست. به بیانی دیگر این مقادیر بیان کننده این نکته هستند که اگر یک فرد با یک تست مورد آزمایش قرار بگیرد، احتمال مثبت یا منفی بودن حقیقی تشخیص در آنها چقدر است.
Emergency physicians face numerous questions regarding proper management of patients and selectio... more Emergency physicians face numerous questions regarding proper management of patients and selection of the best laboratory test or imaging every day. Knowledge on screening performance characteristics of the diagnostic tools used in this department plays an important role in finding the answers to these questions. We assessed these characteristics in the previous parts of educational article series in Emergency journal. In the present manuscript, we will describe how to use these screening characteristics for selecting the right diagnostic tools.
Introduction: An increase in oxidant concentration or a drop in anti-oxidants leads to an imbala... more Introduction: An increase in oxidant concentration or a drop in anti-oxidants leads to an imbalance in oxidant/anti-oxidant equilibrium and a condition called oxidative stress. It seems that recovery from anti-oxidant decrease in this situation can help reduce the effects of the disease and accelerating recovery. Therefore, the present study was designed aiming to evaluate changes in serum paraoxonase-1 levels in thermal burn patients. Methods: This prospective case-control study was carried out from July to October 2014 on thermal burn patient hospitalized in the emergency department of Motahari Hospital, within 4 hours of burning. The control group were healthy people. A checklist consisting of demographic data, medical history, test results, paraclinical measures taken, and serum paraoxonase-1 level was filled for both groups. Finally, SPSS version 19 was used for statistical analysis and comparing the results between the 2 groups. Results: 33 thermal burn patients were compa...
Background: No consensus has been reached on prognostic value of serum concentration of β (beta) ... more Background: No consensus has been reached on prognostic value of serum concentration of β (beta) subunit of human chorionic gonadotropin (β-hCG) in treatment response to methotrexate in management of ectopic pregnancy. Therefore, the present study aimed to evaluate this subject through a systematic review and meta-analysis. Materials and Methods: An extensive literature search on online databases was performed. All studies performed on ectopic pregnancy patients treated by methotrexate from all age groups were included. After collecting data, random effect models were used to calculate the pooled standardized mean difference (SMD) of β-hCG level in treatment success and treatment failure groups. Finally, pooled performance screening characteristics of serum β-hCG level were assessed in different cut offs. Results: Finally, 51 articles were included in meta-analysis. Overall treatment success rate of methotrexate was 84% [95% confidence interval (CI): 84-85 percent]. A negative assoc...
پزشکان اورژانس هر روزه با سوالات متعددی در زمینه مدیریت صحیح بیماران و انتخاب مناسبترین تست آزمای... more پزشکان اورژانس هر روزه با سوالات متعددی در زمینه مدیریت صحیح بیماران و انتخاب مناسبترین تست آزمایشگاهی یا روش تصویربرداری مواجه هستند. آگاهی در مورد ویژگی های غربالگری ابزارهای تشخیصی مورد استفاده در این بخش نقش مهمی در پاسخ به این سوالات بازی می کند. در مقالات گذشته از سری مقالات آموزشی مجله اورژانس به بررسی ویژگی های مذکور پرداختیم. در نوشته حاضر به نحوه استفاده از این ویژگی های غربالگری در انتخاب ابزارهای تشخیصی صحیح خواهیم پرداخت.
Introduction: Successful performance of emergency department(ED) is one of the important indicat... more Introduction: Successful performance of emergency department(ED) is one of the important indications of increasing the satisfaction among referees. The insurance of such successful performance is fiscal discipline and avoiding from non-beneficial activities in this department. Therefore, the increasing revenue of emergency department is one of the interested goals of hospital management system. According to above-mentioned, the researchers assessed problems lead to loss the revenue of ED and eliminate them by using failure mode and effects analysis (FMEA). Methods: This was the prospective cohort study performed during 18 months, set in 6 phases. In the first phase, the failures were determined and some solutions suggested to eliminate them. During 2-5 phases, based on the prioritizing the problems, solutions were performed. In the sixth phase, final assessment of the study was done. Finally, the feedback of system’s revenue was evaluated and data analyzed using repeated measure A...
Multiple diagnostic tools are used by emergency physicians,every day. In addition, new tools are ... more Multiple diagnostic tools are used by emergency physicians,every day. In addition, new tools are evaluated to obtainmore accurate methods and reduce time or cost of conventionalones. In the previous parts of this educationalseries, we described diagnostic performance characteristicsof diagnostic tests including sensitivity, specificity, positiveand negative predictive values, and likelihood ratios. Thereceiver operating characteristics (ROC) curve is a graphicalpresentation of screening characteristics. ROC curve is usedto determine the best cutoff point and compare two or moretests or observers by measuring the area under the curve(AUC). In this part of our educational series, we explain ROCcurve and two methods to determine the best cutoff value.
Multiple diagnostic tools are used by emergency physicians, every day. In addition, new tools are... more Multiple diagnostic tools are used by emergency physicians, every day. In addition, new tools are evaluated to obtain more accurate methods and reduce time or cost of conventional ones. In the previous parts of this educational series, we described diagnostic performance characteristics of diagnostic tests including sensitivity, specificity, positive and negative predictive values, and likelihood ratios. The receiver operating characteristics (ROC) curve is a graphical presentation of screening characteristics. ROC curve is used to determine the best cutoff point and compare two or more tests or observers by measuring the area under the curve (AUC). In this part of our educational series, we explain ROC curve and two methods to determine the best cutoff value.
Introduction: Emergency medicine physicians are constantly under psychological trauma due to enco... more Introduction: Emergency medicine physicians are constantly under psychological trauma due to encountering critically ill patients, mortality, and violence, which can negatively affect their mental and physical health. The present study was performed with the aim of determining the rate of depression and personality disorders in first-year emergency medicine residents and comparing it with the time they reach the 3rd year. Methods: In the present prospective cross-sectional study, emergency medicine residents working in multiple teaching hospitals were included via census method and evaluated regarding the rate of depression and personality disorders using the standard MMPI-2 questionnaire upon admission to the program and graduation and their status regarding the evaluated disorders were compared between the 2 phases of evaluation. Results: 99 residents with the mean age of 33.93 ± 5.92 years were evaluated. 85 (85.85%) rated their interest in their discipline as moderate to high. T...
In the previous two parts of educational manuscript series in Emergency, we explained some screen... more In the previous two parts of educational manuscript series in Emergency, we explained some screening characteristics of diagnostic tests including accuracy, sensitivity, specificity, and positive and negative predictive values. In the 3rd part we aimed to explain positive and negative likelihood ratio (LR) as one of the most reliable performance measures of a diagnostic test. To better understand this characteristic of a test, it is first necessary to fully understand the concept of sensitivity and specificity. So we strongly advise you to review the 1st part of this series again. In short, the likelihood ratios are about the percentage of people with and without a disease but having the same test result. The prevalence of a disease can directly influence screening characteristics of a diagnostic test, especially its sensitivity and specificity. Trying to eliminate this effect, LR was developed. Pre-test probability of a disease multiplied by positive or negative LR can estimate po...
Background: In 2017, the American Academy of Pediatrics (AAP) updated clinical practice guideline... more Background: In 2017, the American Academy of Pediatrics (AAP) updated clinical practice guidelines for the diagnosis and management of hypertension in children. The present study aimed to assess the prevalence of hypertension in Iranian children based on the latest guidelines. Methods: Data on 7301 student participants (3589 boys and 3712 girls) aged between 7-12 yr were assessed. The data were extracted from the fifth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN V) school-based study conducted in the 30 provinces of Iran in 2015. Blood pressure (BP) was classified as normal, elevated BP, and stage 1 and 2 hypertension using weighted analysis and the 2017 AAP guidelines. All analyses were performed in STATA 14.0 statistical software, with findings presented in terms of prevalence. Results: The overall prevalence of high BP in Iranian children was 14.7%. In addition, 15.1% of boys had high BP, with 9.4% and 1.7% of them with stage 1 and 2 hypertension, respectively. Moreover, 14.3% of girls had high BP, of which 10% had stage 1 and 1.3% with stage 2 hypertension. For elevated hypertension, it was observed in 4% of boys and 3% of girls. Conclusion: Using the 2017 AAP guidelines demonstrated a higher prevalence of hypertension in children (14.7%) in Iran. The prevalence of hypertension in boys was slightly higher compared to girls.
Objective: Determining the exact underlying etiology of loss of consciousness (LOC) can become a ... more Objective: Determining the exact underlying etiology of loss of consciousness (LOC) can become a real challenge for physicians due to the broadness of differential diagnoses. The current study aimed to assess the accuracy of a commercially available strip for urine drug screening, in patients presenting with LOC. Methods: One hundred fifty patients with LOC were enrolled in the current cross-sectional study. The diagnostic accuracy of a multidrug urinary strip rapid test was evaluated in comparison to blood analysis as the reference test, and the screening performance characteristics of the rapid test for each substance were estimated. Results: The average age of patients was 46.21±18.59 years (72.67% male). The most frequent false positive results of the test were related to Benzodiazepine (21.5%), Methamphetamine (7.5%), and Tramadol (5.4%), respectively. The screening performance characteristics of the test tape were the best in detection of Amitriptyline with 100.0% (95% CI: 30....
DOAJ (DOAJ: Directory of Open Access Journals), Aug 15, 2015
In the previous two parts of educational manuscript series in Emergency, we explained some screen... more In the previous two parts of educational manuscript series in Emergency, we explained some screening characteristics of diagnostic tests including accuracy, sensitivity, specificity, and positive and negative predictive values. In the 3rd part we aimed to explain positive and negative likelihood ratio (LR) as one of the most reliable performance measures of a diagnostic test. To better understand this characteristic of a test, it is first necessary to fully understand the concept of sensitivity and specificity. So we strongly advise you to review the 1st part of this series again. In short, the likelihood ratios are about the percentage of people with and without a disease but having the same test result. The prevalence of a disease can directly influence screening characteristics of a diagnostic test, especially its sensitivity and specificity. Trying to eliminate this effect, LR was developed. Pre-test probability of a disease multiplied by positive or negative LR can estimate post-test probability. Therefore, LR is the most important characteristic of a test to rule out or rule in a diagnosis. A positive likelihood ratio &gt; 1 means higher probability of the disease to be present in a patient with a positive test. The further from 1, either higher or lower, the stronger the evidence to rule in or rule out the disease, respectively. It is obvious that tests with LR close to one are less practical. On the other hand, LR further from one will have more value for application in medicine. Usually tests with 0.1 &lt; LR &gt; 10 are considered suitable for implication in routine practice.
Introduction: Gathering information regarding the risk factors of mortality and disability due to... more Introduction: Gathering information regarding the risk factors of mortality and disability due to road traffic injuries can provide evidence for adopting effective interventions to reduce the burden of the injury. Therefore, the present study intends to identify the most important risk factors of road accident-related mortality in Iran by conducting a systematic review and meta-analysis. Methods: Search was done in English and Persian electronic databases, for articles published until the end of 2020. Cross-sectional, cohort and case-control studies were included. Risk factors were divided into age and sex, road related factors, exceeding speed limit, road user behaviors, vehicle related factors, weather condition, and light condition. Data were reported as adjusted odds ratio (OR) of death with 95% confidence interval (95% CI). Results: 20 studies were included (2,682,434 traffic accident victims and 23,272 deaths; mortality rate=1.28%). The risk of death in road traffic injuries i...
Introduction: The importance of evaluating performance indicators in the emergency department, a... more Introduction: The importance of evaluating performance indicators in the emergency department, as one of the most important departments of hospital, is obvious to everyone. Therefore, in this study we aimed to appraise the five performance indicators, approved by the ministry of health, in Shohadaye Tajrish hospital, Tehran, Iran. Methods: In a descriptive cross-sectional study based on the profiles of all the patients admitted to the emergency department, performance indicators in the emergency department were evaluated. The study was divided into 2 parts about the establishment of emergency medicine system and training the medical staff: the first 6 months of 1392 and the second. Then these 2 periods were compared using Mann-Whitney U test while P< 0.05 was considered as the level of significance. Results: Of the studied indicators, mean triage time was 6.04 minutes in the first 6 months which was reduced to 1.5 minutes in the second 6 months (p=0.016). In addition, the pe...
Background and Aim: Homelessness is a social problem with various contributory factors. This unde... more Background and Aim: Homelessness is a social problem with various contributory factors. This undesirable phenomenon involves various sections of civil and law enforcement in the community. The aim of this study was to determine the prevalence of disease and other complaints in homeless patients on admission to the Emergency Department of Imam Hossein Hospital, Tehran, Iran from 2012 to 2018. Methods: This retrospective descriptive study was carried out in Imam Hossein Hospital affiliated to Shahid Beheshti University of Medical Sciences. All homeless patients referring to emergency department of Imam Hossein Hospital from 2012 to 2018 were included in study. The data collection tool was a researcher-made checklist that included demographic features such as age and sex, and clinical conditions such as blood factors, hepatitis B and C status, HIV infection, blood culture, urine culture, abdominal fluid culture, complaints on admission, diagnosis and clinical outcome (discharge, operat...
در شماره 2، دوره 2، صفحات 105-107 مجله طب اورژانس ایران بعضی از ویژگی های تست های تشخیصی در قالب ... more در شماره 2، دوره 2، صفحات 105-107 مجله طب اورژانس ایران بعضی از ویژگی های تست های تشخیصی در قالب یک مقاله آموزشی با عنوان "پزشکی مبتنی بر شواهد؛ قسمت اول: تعریف و محاسبه ساده حساسیت، ویژگی و دقت یک تست" تعریف شده و نحوه محاسبه آنها بیان گردید. مقاله حاضر قصد دارد تا دو ویژگی دیگر تست های تشخیصی شامل ارزش اخباری مثبت و منفی را مورد توجه قرار دهد. ارزش اخباری مثبت و منفی به ترتیب عبارتند از موارد مثبت و منفی حقیقی گزارش شده توسط یک تست. به بیانی دیگر این مقادیر بیان کننده این نکته هستند که اگر یک فرد با یک تست مورد آزمایش قرار بگیرد، احتمال مثبت یا منفی بودن حقیقی تشخیص در آنها چقدر است.
Emergency physicians face numerous questions regarding proper management of patients and selectio... more Emergency physicians face numerous questions regarding proper management of patients and selection of the best laboratory test or imaging every day. Knowledge on screening performance characteristics of the diagnostic tools used in this department plays an important role in finding the answers to these questions. We assessed these characteristics in the previous parts of educational article series in Emergency journal. In the present manuscript, we will describe how to use these screening characteristics for selecting the right diagnostic tools.
Introduction: An increase in oxidant concentration or a drop in anti-oxidants leads to an imbala... more Introduction: An increase in oxidant concentration or a drop in anti-oxidants leads to an imbalance in oxidant/anti-oxidant equilibrium and a condition called oxidative stress. It seems that recovery from anti-oxidant decrease in this situation can help reduce the effects of the disease and accelerating recovery. Therefore, the present study was designed aiming to evaluate changes in serum paraoxonase-1 levels in thermal burn patients. Methods: This prospective case-control study was carried out from July to October 2014 on thermal burn patient hospitalized in the emergency department of Motahari Hospital, within 4 hours of burning. The control group were healthy people. A checklist consisting of demographic data, medical history, test results, paraclinical measures taken, and serum paraoxonase-1 level was filled for both groups. Finally, SPSS version 19 was used for statistical analysis and comparing the results between the 2 groups. Results: 33 thermal burn patients were compa...
Background: No consensus has been reached on prognostic value of serum concentration of β (beta) ... more Background: No consensus has been reached on prognostic value of serum concentration of β (beta) subunit of human chorionic gonadotropin (β-hCG) in treatment response to methotrexate in management of ectopic pregnancy. Therefore, the present study aimed to evaluate this subject through a systematic review and meta-analysis. Materials and Methods: An extensive literature search on online databases was performed. All studies performed on ectopic pregnancy patients treated by methotrexate from all age groups were included. After collecting data, random effect models were used to calculate the pooled standardized mean difference (SMD) of β-hCG level in treatment success and treatment failure groups. Finally, pooled performance screening characteristics of serum β-hCG level were assessed in different cut offs. Results: Finally, 51 articles were included in meta-analysis. Overall treatment success rate of methotrexate was 84% [95% confidence interval (CI): 84-85 percent]. A negative assoc...
پزشکان اورژانس هر روزه با سوالات متعددی در زمینه مدیریت صحیح بیماران و انتخاب مناسبترین تست آزمای... more پزشکان اورژانس هر روزه با سوالات متعددی در زمینه مدیریت صحیح بیماران و انتخاب مناسبترین تست آزمایشگاهی یا روش تصویربرداری مواجه هستند. آگاهی در مورد ویژگی های غربالگری ابزارهای تشخیصی مورد استفاده در این بخش نقش مهمی در پاسخ به این سوالات بازی می کند. در مقالات گذشته از سری مقالات آموزشی مجله اورژانس به بررسی ویژگی های مذکور پرداختیم. در نوشته حاضر به نحوه استفاده از این ویژگی های غربالگری در انتخاب ابزارهای تشخیصی صحیح خواهیم پرداخت.
Introduction: Successful performance of emergency department(ED) is one of the important indicat... more Introduction: Successful performance of emergency department(ED) is one of the important indications of increasing the satisfaction among referees. The insurance of such successful performance is fiscal discipline and avoiding from non-beneficial activities in this department. Therefore, the increasing revenue of emergency department is one of the interested goals of hospital management system. According to above-mentioned, the researchers assessed problems lead to loss the revenue of ED and eliminate them by using failure mode and effects analysis (FMEA). Methods: This was the prospective cohort study performed during 18 months, set in 6 phases. In the first phase, the failures were determined and some solutions suggested to eliminate them. During 2-5 phases, based on the prioritizing the problems, solutions were performed. In the sixth phase, final assessment of the study was done. Finally, the feedback of system’s revenue was evaluated and data analyzed using repeated measure A...
Multiple diagnostic tools are used by emergency physicians,every day. In addition, new tools are ... more Multiple diagnostic tools are used by emergency physicians,every day. In addition, new tools are evaluated to obtainmore accurate methods and reduce time or cost of conventionalones. In the previous parts of this educationalseries, we described diagnostic performance characteristicsof diagnostic tests including sensitivity, specificity, positiveand negative predictive values, and likelihood ratios. Thereceiver operating characteristics (ROC) curve is a graphicalpresentation of screening characteristics. ROC curve is usedto determine the best cutoff point and compare two or moretests or observers by measuring the area under the curve(AUC). In this part of our educational series, we explain ROCcurve and two methods to determine the best cutoff value.
Multiple diagnostic tools are used by emergency physicians, every day. In addition, new tools are... more Multiple diagnostic tools are used by emergency physicians, every day. In addition, new tools are evaluated to obtain more accurate methods and reduce time or cost of conventional ones. In the previous parts of this educational series, we described diagnostic performance characteristics of diagnostic tests including sensitivity, specificity, positive and negative predictive values, and likelihood ratios. The receiver operating characteristics (ROC) curve is a graphical presentation of screening characteristics. ROC curve is used to determine the best cutoff point and compare two or more tests or observers by measuring the area under the curve (AUC). In this part of our educational series, we explain ROC curve and two methods to determine the best cutoff value.
Introduction: Emergency medicine physicians are constantly under psychological trauma due to enco... more Introduction: Emergency medicine physicians are constantly under psychological trauma due to encountering critically ill patients, mortality, and violence, which can negatively affect their mental and physical health. The present study was performed with the aim of determining the rate of depression and personality disorders in first-year emergency medicine residents and comparing it with the time they reach the 3rd year. Methods: In the present prospective cross-sectional study, emergency medicine residents working in multiple teaching hospitals were included via census method and evaluated regarding the rate of depression and personality disorders using the standard MMPI-2 questionnaire upon admission to the program and graduation and their status regarding the evaluated disorders were compared between the 2 phases of evaluation. Results: 99 residents with the mean age of 33.93 ± 5.92 years were evaluated. 85 (85.85%) rated their interest in their discipline as moderate to high. T...
In the previous two parts of educational manuscript series in Emergency, we explained some screen... more In the previous two parts of educational manuscript series in Emergency, we explained some screening characteristics of diagnostic tests including accuracy, sensitivity, specificity, and positive and negative predictive values. In the 3rd part we aimed to explain positive and negative likelihood ratio (LR) as one of the most reliable performance measures of a diagnostic test. To better understand this characteristic of a test, it is first necessary to fully understand the concept of sensitivity and specificity. So we strongly advise you to review the 1st part of this series again. In short, the likelihood ratios are about the percentage of people with and without a disease but having the same test result. The prevalence of a disease can directly influence screening characteristics of a diagnostic test, especially its sensitivity and specificity. Trying to eliminate this effect, LR was developed. Pre-test probability of a disease multiplied by positive or negative LR can estimate po...
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