Development of a Non-invasive Device for Swallow Screening in Patients at Risk of Oropharyngeal Dysphagia: Results from a Prospective Exploratory Study

AbstractCurrent non-invasive approaches for bladder cancer (BC) detection are suboptimal. We report the development of non-invasive molecular test for BC using DNA recovered from cells shed into urine. This “UroSEEK” test incorporates assays for mutations in 11 genes and copy number changes on 39 chromosome arms. We first evaluated 570 urine samples from patients at risk for BC (microscopic hematuria or dysuria). UroSEEK was positive in 83% of patients that developed BC, but in only 7% of patients who did not develop BC. Combined with cytology, 95% of patients that developed BC were positive. We then evaluated 322 urine samples from patients soon after their BCs had been surgically resected. UroSEEK detected abnormalities in 66% of the urine samples from these patients, sometimes up to 4 years prior to clinical evidence of residual neoplasia, while cytology was positive in only 25% of such urine samples. The advantages of UroSEEK over cytology were particularly evident in low-grade tumors, wherein cytology detected none while UroSEEK detected 67% of 49 cases. These results establish the foundation for a new, non-invasive approach to the detection of BC in patients at risk for initial or recurrent disease.

Download Full-text

Non Invasive Assessment of Hepatic Fibrosis by Measurement of Liver Stiffness in Post Transfusional Iron Overload: Preliminary Results in 15 Patients.

Blood ◽

10.1182/blood.v108.11.3740.3740 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3740-3740

Author(s):

T. Mirault ◽

D. Lucidarme ◽

B. Turlin ◽

Y. Deugnier ◽

P. Brissot ◽

...

Keyword(s):

At Risk ◽

Liver Fibrosis ◽

Iron Overload ◽

Predictive Value ◽

Liver Stiffness ◽

Liver Iron ◽

Preliminary Results ◽

Non Invasive ◽

Patients At Risk ◽

Severe Fibrosis

Abstract Background: The prognosis of liver iron overload is highly dependent on liver iron content (LIC) and the extent of liver fibrosis. Liver biopsy is the invasive reference method for fibrosis evaluation but with several limitations. Non-invasive biological methods (FibroTest, APRI) are not applicable in blood diseases. Transient elastography (TE) is a new non-invasive and rapid bedside method used to measure liver stiffness.This technique has been extensively studied with success in evaluation of liver fibrosis in HCV infection (Ziol, Hepatology 2005; Castera, Gastroenterology 2005). Until now, no data are available on evaluation of liver fibrosis by TE in highly transfused patients with iron overload. Methods: We assessed liver stiffness (kPa) by elastography measurement (Fibroscan; Echosens, Paris, France). Ishak’s and Metavir’s scales were used to stage fibrosis and hepatitis activity; LIC was measured by atomic absorption spectometry in a central laboratory (Rennes, France) and by MRI procedure according to Gandon (Lancet 2004). Cardiac MRI T2* (indirect estimation of iron heart content) was also measured by MRI according to Anderson (Eur Heart J 2001). Serum ferritin level and HCV serology were assayed in all cases. Correlation statistical analysis used Spearman’s Rho and Pearson tests and mean comparisons were done by a non-parametric Mann-Whitney test. Results: 15 liver samples (weight >1mg except 1) from monthly transfused patients (13 major beta Thalassemia, 1 sickle cell disease, 1 myelodysplastic syndrome) were analyzed. Median age was 37 years (7–75). Histological results were: 3 cirrhosis (METAVIR F=4 (F4), or Ishak’s Staging =6 (IS6)) among 5 patients with severe fibrosis (F3,F4) or (IS4-6) and 10 patients with no or mild fibrosis (F0-2) or (IS0-3). Mean ferritin was 2579 ng/ml CI 95% [1372–3786]. 2 patients were HCV positive. Correlation between LIC and ferritin was 0.82 (p<0,05); between LIC and MRI LIC: 0.88 (p<0,05); LIC and MRI Heart T2*: 0.72(p<0,05); METAVIR F score and Ishak’s grading score: 0.86 (p<0,05). A correlation was also observed between METAVIR F and elastography: 0.60(p<0,05); and mean values of elastography were significally different in patients with severe fibrosis: 9.1kPa CI95% [4.5–13.7] vs 5.9kPa CI95% [4.6–7.2] in those without sever fibrosis (p<0,05) (fig). A value of elastography above 6.25kPa (Se=80%; Sp=70%; AUROC=0.820) identified patients at risk for severe fibrosis (F3,F4 or IS 4–6) (Negative Predictive Value = 88%; Positive Predictive Value = 57%). Conclusion: A significant correlation between Metavir Fibrosis scale and elastography values was found. This new non-invasive method would be helpful to evaluate liver fibrosis and to determine patients who could avoid invasive procedures in particular in regularly transfused low risk myelodysplastic patients at risk of bleeding due to abnormal platelet function. These preliminary results will have to be confirmed in a larger population. Figure Figure

Download Full-text

Ultrasound monitoring of tissue changes in patients at risk of developing pressure ulcers: an exploratory study

http://isrctn.org/> ◽

10.1186/isrctn66819676 ◽

2012 ◽

Author(s):

Alison Porter-Armstrong

Keyword(s):

At Risk ◽

Exploratory Study ◽

Pressure Ulcers ◽

Ultrasound Monitoring ◽

Patients At Risk ◽

Tissue Changes

Download Full-text

RESPIRATORY COMPLICATIONS IN A COHORT OF PATIENTS AT RISK FOR OROPHARYNGEAL DYSPHAGIA

CHEST Journal ◽

10.1378/chest.134.4_meetingabstracts.p11004 ◽

2008 ◽

Vol 134 (4) ◽

pp. 11P

Author(s):

Luis F. Giraldo ◽

Ximena Miranda ◽

Camilo Barros ◽

Mauricio Hernandez ◽

Nicolas Martinez ◽

...

Keyword(s):

At Risk ◽

Oropharyngeal Dysphagia ◽

Respiratory Complications ◽

Patients At Risk

Download Full-text

Validation of Serum Aspergillus Galactomannan Index as a Surrogate Endpoint for Outcome of Invasive Aspergillosis: Clinical and Research Implications.

Blood ◽

10.1182/blood.v108.11.2861.2861 ◽

2006 ◽

Vol 108 (11) ◽

pp. 2861-2861 ◽

Cited By ~ 3

Author(s):

Gail Woods ◽

Marisa Miceli ◽

Monica Grazziutti ◽

Somashekar Krishna ◽

Nayyar Syed ◽

...

Keyword(s):

At Risk ◽

Clinical Outcome ◽

Invasive Aspergillosis ◽

Composite Endpoint ◽

Surrogate Endpoint ◽

Laboratory Findings ◽

Hematological Cancer ◽

Non Invasive ◽

Patients At Risk ◽

Neutropenic Patients

Abstract Background: Assessing clinical outcome of aspergillosis with conventional clinical and laboratory criteria is difficult. A composite “global outcome response” (clinical, radiologic, pathologic and microbiologic criteria) is frequently used but suffers from poor sensitivity and specificity, and has not been standardized or validated. A reliable, quantitative, non-invasive, and easy to measure laboratory test than can substitute for this composite endpoint, i.e. serve as a surrogate endpoint for aspergillosis outcome is highly desirable. Galactomannan (GM) is an Aspergillus-specific polysaccharide released during aspergillosis and detected by the serum GM test. The test which is reported as an index of optical density (OD) is an accepted diagnostic marker for aspergillosis and preliminary data suggest a correlation between GM index (GMI) and outcome. Purpose: To evaluate serum GMI as a surrogate endpoint for outcome of invasive aspergillosis in patients with hematological cancer. Patients and Methods: patients at risk for aspergillosis (11/03-2/06) underwent GMI screening during periods at risk. The clinical and laboratory findings of patients with ≥ 2 (+) GMI (OD ≥ 0.5) were reviewed. To validate GMI as a surrogate endpoint for aspergillosis, a k correlation concordance coefficient test between GMI and an objective clinical outcome of aspergillosis (death) was applied. The correlation is considered perfect when k is 1.0; excellent when ≥ 0.75. Results: 30 patients had GMI (+) aspergillosis of the respiratory tract [myeloma 92%; median age: 59 years (27–75); 15 males]. Aspergillosis developed following stem cell transplantation [autologous (11), allogeneic (1)], or after conventional chemotherapy (18). Among 25 neutropenic patients (<1000/ml), persistent GMI elevation was associated with death (5/5 patients) while return to negative values predicted survival (20/20 patients). Among 5 non-neutropenic patients, 1 with persistently elevated GMI died compared to no death among the remaining 4 whose GMI became negative. Overall, the GMI correlated with clinical outcome in all 30 patients with a perfect 1.0 k correlation concordance coefficient. Conclusion: we have validated GMI as an excellent surrogate endpoint for the outcome of invasive aspergillosis among patients with hematological cancer. This FDA-approved test is reproducible, quantitative, non-invasive, easy to measure and widely available. These findings have important implications for patient care and for the design of clinical trials of mould-active antifungal agents.

Download Full-text

Application of Viscosity Volume Screening Tool as a screening tool in swallowing disorders diagnosis

Polski Przegląd Otorynolaryngologiczny ◽

10.5604/01.3001.0012.0982 ◽

2018 ◽

Vol 7 (2) ◽

pp. 6-10

Author(s):

Barbara Jamróz ◽

Magdalena Milewska ◽

Pere Clave ◽

Joanna Chmielewska

Keyword(s):

At Risk ◽

Treatment Cost ◽

Screening Tool ◽

Risk Groups ◽

Swallowing Disorders ◽

Screening Tests ◽

Non Invasive ◽

Risk Of Mortality ◽

Patients At Risk ◽

Instrumental Methods

It is commonly known that dysphagia is associated with primary (malnutrition, dehydration, aspiration pneumonia) as well as secondary consequences (longer hospital stay, increased treatment cost, higher risk of mortality). Therefore screening tests in swallowing disorders, especially at risk groups are essential. The aim of screening is identification of patients at risk of dysphagia and referring patient to further instrumental methods. Test should be non invasive, quick, easy to perform by medical staff, with highest sensitivity and specifity. One of the test is Viscosity – Volume Screening Test (VVST) with 3 different consistencies at 3 volumes (5, 10 and 20 ml), what wider possibilities of these tool in safe consistency and volume indication.

Download Full-text

Cardiovascular Evaluation of Liver Transplant Patients by Using Coronary Calcium Scoring in ECG-Synchronized Computed Tomographic Scans

Journal of Clinical Medicine ◽

10.3390/jcm10215148 ◽

2021 ◽

Vol 10 (21) ◽

pp. 5148

Author(s):

Anna Bettina Roehl ◽

Marc Hein ◽

Johanna Kroencke ◽

Felix Kork ◽

Alexander Koch ◽

...

Keyword(s):

At Risk ◽

Prognostic Impact ◽

Stress Tests ◽

Predictive Values ◽

Computed Tomographic ◽

Non Invasive ◽

Transplant Patients ◽

Cardiac Evaluation ◽

Patients At Risk ◽

Cardiovascular Evaluation

Background: The goal of cardiac evaluation of patients awaiting orthotopic liver transplantation (OLT) is to identify the patients at risk for cardiovascular events (CVEs) in the peri- and postoperative periods by opportunistic evaluation of coronary artery calcium (CAC) in non-gated abdominal computed tomographs (CT). Methods: We hypothesized that in patients with OLT, a combination of Lee’s revised cardiac index (RCRI) and CAC scoring would improve diagnostic accuracy and prognostic impact compared to non-invasive cardiac testing. Therefore, we retrospectively evaluated 169 patients and compared prediction of CVEs by both methods. Results: Standard workup identified 22 patients with a high risk for CVEs during the transplant period, leading to coronary interventions. Eighteen patients had a CVE after transplant and a CAC score > 0. The combination of CAC and RCRI ≥ 2 had better negative (NPV) and positive predictive values (PPV) for CVEs (NPV 95.7%, PPV 81.6%) than standard non-invasive stress tests (NPV 92.0%, PPV 54.5%). Conclusion: The cutoff value of CAC > 0 by non-gated CTs combined with RCRI ≥ 2 is highly sensitive for identifying patients at risk for CVEs in the OLT population.

Download Full-text

Testing the Accuracy of a Bedside Screening Tool Framework to Clinical Records for Identification of Patients at Risk of Malnutrition in a Rural Setting: An Exploratory Study

Nutrients ◽

10.3390/nu14010205 ◽

2022 ◽

Vol 14 (1) ◽

pp. 205

Author(s):

Laura Alston ◽

Megan Green ◽

Melanie Nichols ◽

Stephanie R. Partridge ◽

Alison Buccheri ◽

...

Keyword(s):

At Risk ◽

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Exploratory Study ◽

Screening Tool ◽

Rural Setting ◽

Receiver Operating Curve ◽

Specificity And Sensitivity ◽

Patients At Risk ◽

Clinical Records

This study aimed to explore the diagnostic accuracy of the Patient-Generated Subjective Global Assessment (PG-SGA) malnutrition risk screening tool when used to score patients based on their electronic medical records (EMR), compared to bedside screening interviews. In-patients at a rural health service were screened at the bedside (n = 50) using the PG-SGA, generating a bedside score. Clinical notes within EMRs were then independently screened by blinded researchers. The accuracy of the EMR score was assessed against the bedside score using area under the receiver operating curve (AUC), sensitivity, and specificity. Participants were 62% female and 32% had conditions associated with malnutrition, with a mean age of 70.6 years (SD 14.9). The EMR score had moderate diagnostic accuracy relative to PG-SGA bedside screen, AUC 0.74 (95% CI: 0.59–0.89). The accuracy, specificity and sensitivity of the EMR score was highest for patients with a score of 7, indicating EMR screen is more likely to detect patients at risk of malnutrition. This exploratory study showed that applying the PG-SGA screening tool to EMRs had enough sensitivity and specificity for identifying patients at risk of malnutrition to warrant further exploration in low-resource settings.

Download Full-text