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Articles by R. Wolfe
Total Records ( 2 ) for R. Wolfe
  O Thom , D. M Taylor , R. E Wolfe , J Cade , P Myles , H Krum and R. Wolfe
  Background

Cardiac output (CO) cannot reliably be estimated by clinical examination. We aimed to measure the agreement between CO measurements using a supra-sternal Doppler monitor (USCOM, Coffs Harbour, Australia) and the pulmonary artery catheter (PAC).

Methods

The study was conducted in the intensive care unit of a tertiary teaching hospital. All patients with PAC in situ were eligible. Simultaneous CO readings were taken when clinically indicated. Investigators and clinicians were blinded to each other's results. The CO values used were the mean of three consecutive supra-sternal Doppler readings for patients with a sinus rhythm and seven for atrial fibrillation, and the mean of three thermodilution curves with acceptable form and values within 10% of each other for the PAC. Agreement was measured using both the paired t-test to calculate bias and limits of agreement and the intraclass correlation (ICC) coefficient.

Results

Ninety-four subjects were enrolled. From 89 subjects, 250 paired comparisons were obtained. USCOM monitor readings were unobtainable in five patients. Mean supra-sternal Doppler CO was 5.5 litre min–1. Bias was –0.09 litre min–1 and levels of agreement were ± 2.92 litre min–1 when compared with PAC. ICC was 0.46 (95% CI 0.36–0.56), and mean percentage difference was 19 (IQR 6–31)%.

Conclusions

In our subjects, there was poor agreement between CO measurements done with the supra-sternal Doppler monitor and PAC.

  L. Chen , D. J. Magliano , B. Balkau , R. Wolfe , L. Brown , A. M. Tonkin , P. Z. Zimmet and J. E. Shaw
  Aims  To evaluate how to most efficiently screen populations to detect people at high risk of incident Type 2 diabetes and those with prevalent, but undiagnosed, Type 2 diabetes.

Methods  Data from 5814 adults in the Australian Diabetes, Obesity and Lifestyle study were used to examine four different types of screening strategies. The strategies incorporated various combinations of cut-points of fasting plasma glucose, the non-invasive Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK1) and a modified version of the tool incorporating fasting plasma glucose (AUSDRISK2). Sensitivity, specificity, positive predictive value, screening costs per case of incident or prevalent undiagnosed diabetes identified and intervention costs per case of diabetes prevented or reverted were compared.

Results  Of the four strategies that maximized sensitivity and specificity, use of the non-invasive AUSDRISK1, followed by AUSDRISK2 in those found to be at increased risk on AUSDRISK1, had the highest sensitivity (80.3%; 95% confidence interval 76.6-84.1%), specificity (78.1%; 95% confidence interval 76.9-79.2%) and positive predictive value (22.3%; 95% confidence interval 20.2-24.4%) for identifying people with either prevalent undiagnosed diabetes or future incident diabetes. It required the fewest people (24.1%; 95% confidence interval 23.0-25.2%) to enter lifestyle modification programmes, and also had the lowest intervention costs and combined costs of running screening and intervention programmes per case of diabetes prevented or reverted.

Conclusions  Using a self-assessed diabetes risk score as an initial screening step, followed by a second risk score incorporating fasting plasma glucose, would maximize efficiency of identifying people with undiagnosed Type 2 diabetes and those at high risk of future diabetes.

 
 
 
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