Is there a primary care tool to detect aberrant drug-related behaviors in patients on opioids?

Of the several screening instruments developed and originally validated in patients in a pain center population (TABLE), one also has been validated in primary care. The Current Opioid Misuse Measure (COMM) predicts aberrant drug-related behaviors in primary care patients who have been prescribed opioids within the past 12 months with a sensitivity of 77% and specificity of 77% (strength of recommendation [SOR]: B, cohort studies). Although not validated in primary care populations, 3 other instruments (the Addiction Behaviors Checklist [ABC], Prescription Opioid Misuse Index [POMI], and prescription Drug Use Questionnaire [PDUQ]) detect aberrant drug-related behaviors in pain center patients with chronic pain with sensitivities of 82% to 87.5% and specificities of 86.14% to 92.3% (SOR: B, cohort studies)

Personality traits and mental disorders

Peer reviewe

Rapid Antigen Group A Streptococcus Test to Diagnose Pharyngitis: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Pharyngitis management guidelines include estimates of the test characteristics of rapid antigen streptococcus tests (RAST) using a non-systematic approach.</p><p>Objective</p><p>To examine the sensitivity and specificity, and sources of variability, of RAST for diagnosing group A streptococcal (GAS) pharyngitis.</p><p>Data Sources</p><p>MEDLINE, Cochrane Reviews, Centre for Reviews and Dissemination, Scopus, SciELO, CINAHL, guidelines, 2000–2012.</p><p>Study Selection</p><p>Culture as reference standard, all languages.</p><p>Data Extraction and Synthesis</p><p>Study characteristics, quality.</p><p>Main Outcome(s) and Measure(s)</p><p>Sensitivity, specificity.</p><p>Results</p><p>We included 59 studies encompassing 55,766 patients. Forty three studies (18,464 patients) fulfilled the higher quality definition (at least 50 patients, prospective data collection, and no significant biases) and 16 (35,634 patients) did not. For the higher quality immunochromatographic methods in children (10,325 patients), heterogeneity was high for sensitivity (inconsistency [<i>I²</i>] 88%) and specificity (<i>I²</i> 86%). For enzyme immunoassay in children (342 patients), the pooled sensitivity was 86% (95% CI, 79–92%) and the pooled specificity was 92% (95% CI, 88–95%). For the higher quality immunochromatographic methods in the adult population (1,216 patients), the pooled sensitivity was 91% (95% CI, 87 to 94%) and the pooled specificity was 93% (95% CI, 92 to 95%); however, heterogeneity was modest for sensitivity (<i>I²</i> 61%) and specificity (<i>I²</i> 72%). For enzyme immunoassay in the adult population (333 patients), the pooled sensitivity was 86% (95% CI, 81–91%) and the pooled specificity was 97% (95% CI, 96 to 99%); however, heterogeneity was high for sensitivity and specificity (both, <i>I²</i> 88%).</p><p>Conclusions</p><p>RAST immunochromatographic methods appear to be very sensitive and highly specific to diagnose group A streptococcal pharyngitis among adults but not in children. We could not identify sources of variability among higher quality studies. The present systematic review provides the best evidence for the wide range of sensitivity included in current guidelines.</p></div

PRISMA Flow Diagram.

<p>PRISMA Flow Diagram.</p

Pediatric strata, forest plots for immunochromatographic methods, higher study methodological quality.

<p>Pediatric strata, forest plots for immunochromatographic methods, higher study methodological quality.</p

Pediatric strata, forest plots for enzyme immunoassay (EIA, top panels) and optical immunoassay (OIA, bottom panels) methods to diagnose group A streptococcal pharyngitis, higher study methodological quality.

<p>Pediatric strata, forest plots for enzyme immunoassay (EIA, top panels) and optical immunoassay (OIA, bottom panels) methods to diagnose group A streptococcal pharyngitis, higher study methodological quality.</p

Adult strata, forest plots for immunochromatographic (top panels), enzyme immunoassay (EIA, middle panels) and optical immunoassay (OIA, bottom panels) methods to diagnose group A streptococcal pharyngitis, higher study methodological quality.

<p>Adult strata, forest plots for immunochromatographic (top panels), enzyme immunoassay (EIA, middle panels) and optical immunoassay (OIA, bottom panels) methods to diagnose group A streptococcal pharyngitis, higher study methodological quality.</p

Quality Assessment of Diagnostic Accuracy Studies (QUADAS) assessments of the quality of included studies.

<p>Quality Assessment of Diagnostic Accuracy Studies (QUADAS) assessments of the quality of included studies.</p

Summary of diagnostic accuracy estimates, higher study methodological quality^*.

<p>*Numbers in parenthesis are 95% confidence intervals.</p><p>Summary of diagnostic accuracy estimates, higher study methodological quality^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0111727#nt101" target="_blank">*</a>}.</p

Models of personality structure

In the present chapter, models of personality structure are discussed. With the term “personality structure” we refer to the organization of the various features of personality as based in theory or in empirical findings. By adding the term “models,” the structure quality seems a bit tautological because a model is usually recognized by its typical form or its organization. Most of the ambiguity in the expression “models of personality structure,” is, however, in the term “model” (from the Latin modulus, diminutive of measure or standard), as the term has accrued a variety of functions which can appear at different levels of abstraction