IntroductionA nomogram for predicting the diagnosis of lower urinary tract obstruction (LUTO) based on an antenatal ultrasound index generated from a Bayesian Meta‐regression analysis has been in development and noted with superior diagnostic accuracy compared to the keyhole sign (KHS). We aim to assess the accuracy of the nomogram in expanded diagnostic utilization to predict LUTO.MethodologyThe validation of the nomogram for expanded diagnostic utilization was based on data from a prospective institutional antenatal clinic database between January 2020 and June 2022. Diagnostic accuracy indices were determined for confirmed postnatal diagnosis of LUTO or prune belly syndrome (PBS). Receiver operating characteristics (ROC) curves were generated to compare the area under the curve (AUC) of the nomogram versus KHS.ResultsBased on 84 male fetuses with antenatal ultrasound of moderate‐severe hydronephrosis (PUV n = 15, PBS n = 4), the KHS had 26.3% (95%CI 9.1–51.2) sensitivity and 100% (95%CI 94.4%–100%) specificity, with 14 false‐negatives. The nomogram showed a 84.2 (95%CI 60.4%–96.6%) sensitivity and 95.4 (95%CI 87.1%–99%) specificity with three false‐positives. The nomogram also had a superior AUC compared to KHS (0.98 vs. 0.63).ConclusionThe nomogram can be used as a valuable tool to trigger further postnatal screening and provide individualized risk assessments to families during prenatal counseling.
AimTo assess parental understanding of idiopathic nephrotic syndrome (INS) and its management, to enable targeted education in areas of deficit.MethodsFamilies of children with at least one relapse of INS were interviewed, following a template covering key domains of (a) disease understanding, (b) management of INS and (c) access to information. Common trends and responses were identified and notable observations recorded.ResultsTwenty‐one parents were interviewed. The mean duration of INS was 4.4 years (range 0.5‐14.5 years), with a mean of two steroid‐sparing agents used. Although 90% parents self‐reported that they understood INS, only 29% could appropriately define relapse and 24% name potential complications. The management of INS was generally good, with most parents appropriately testing urine (81%) and managing relapses (90%). Unnecessary dietary restrictions were imposed on 57% during remission. The Internet was searched by 90% of parents for disease and drug information. Further information was desired in paper form (71%), hospital website (81%) and face‐to‐face workshop (90%), plus educational materials for schools.ConclusionParents overestimated their understanding of INS; however, their management was generally well done. Parents desired more information and support in various forms.
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