Robust cost efficacy of a novel, validated screening test at 12–20 Weeks gestation for the prediction of preterm birth (PTB) at or before 32 Weeks in singletons

Abstract Background The standard practice for diagnosis of heparin-induced thrombocytopenia (HIT) involves a combination of 4T score and laboratory tests, such as enzyme immunoassay for detection of antibodies. We noted a lack of widespread use of 4T score in our practice setting. We also found that our laboratory utilized Particle Immunofiltration Assay (PIFA) for HIT screening, which has been shown to have questionable diagnostic utility in HIT diagnosis (Warkentin et al., 2007). The study aims to improve the rate of 4T score usage in conjunction with an improved laboratory diagnostic test for patients with suspected HIT in a cost-efficient manner. Method We initiated a quality improvement project involving the review of all patients with laboratory orders for PIFA testing between March 2017 to March 2018, explicitly assessing for documented 4T scores before the ordering of PIFA. Three of the investigators also calculated 4T scores for these patients at the time of laboratory testing and noted the results of the serotonin release assay (SRA), if ordered. We further collected data on any alternative anti-coagulation used in such patients for a cost-efficacy analysis later. Results A total of 170 PIFA tests were ordered during the period of investigation. Only five (0.02%) of these patients had a documented 4T score at the time of testing. One hundred thirteen patients (66.4%) had a low 4T score per investigator-calculation. Forty-seven patients (27.6%) were noted to have intermediate 4T scores. Lastly, ten patients (0.05%) were observed to have high 4T scores. A total of 32 SRAs were ordered; five of which were positive (four with an intermediate 4T score and one with high 4T score). PIFA was false-negative in two confirmed cases of positive SRA and false-positive in 13 instances of negative SRA. Thus, in this study, the sensitivity of PIFA was noted to be 60%, and specificity was observed to be 50%. Nineteen patients also received alternative parenteral anti-coagulation (fondaparinux or argatroban); seven of these were with low, eight with intermediate, and four with high 4T scores. Conclusion The study highlights the need for improving 4T score usage rates in our hospital as well as a need for switching to an alternative HIT screening test to promote patient safety and cost efficacy. Hence, we have begun the integration of 4T score with laboratory testing into the electronic medical record, alongside a shift in our HIT screening test from PIFA to the recently FDA-approved automated latex immunoturbidimetric assay. We will be continuing analysis of patients with suspected HIT for another six months to assess the effects of the above interventions. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Evaluation of Cost Efficacy of Social Measures for Prevention of Preterm Birth

Third International Conference on System Science in Health Care - Health Systems Research ◽

10.1007/978-3-642-69939-9_126 ◽

1984 ◽

pp. 554-556

Author(s):

N. Mamelle ◽

G. Duru ◽

J. Bougault ◽

N. Eyraud

Keyword(s):

Preterm Birth ◽

Cost Efficacy

Download Full-text

Maternal and Neonatal Outcomes of Syrian Adolescent Refugees and Local Adolescent Turkish Citizens: A Comparative Study at a Tertiary Care Maternity Hospital in Turkey

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2021.1186 ◽

2021 ◽

pp. 1-9

Author(s):

Ceren Golbasi ◽

Tayfun Vural ◽

Burak Bayraktar ◽

Hakan Golbasi ◽

Alkim Gulsah Sahingoz Yildirim

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Pregnant Women ◽

Screening Test ◽

Tertiary Care ◽

Obstetric Outcomes ◽

Syrian Refugees ◽

Average Birth Weight ◽

Adolescent Refugees

OBJECTIVE: In this study, we aim to compare the maternal and obstetric outcomes between local adolescent Turkish citizens and adolescent Syrian refugees admitted to a tertiary care center in Turkey. STUDY DESIGN: Between January 2014 and December 2019, a total of 57,049 births were performed in our hospital. The study included a total of 6,021 patients aged 19 years or younger pregnancy who gave birth at our hospital. Of this number, 5,164 (1,792 Syrian adolescent refugee cases and 3,372 local adolescent Turkish cases) were live singleton pregnancies. Our primary aim was to compare the maternal and obstetric outcomes between the two groups. RESULTS: In the pregnant refugee women, the maternal age was younger (p<0.001). Hemoglobin and hematocrit levels are significantly lower in Syrian pregnant women (p<0.001 and p<0.001, respectively). Anemia was significantly higher in Syrian refugee pregnant women (p<0.001). The double screening test and triple screening test were significantly lower in Syrian pregnant women (p<0.001 and p<0.001, respectively). Preterm birth rates and late preterm delivery prevalence (34-37 gestational weeks) were significantly higher in the adolescent Syrian immigrants' compared to the adolescent Turkish locals (p<0.001 and p<0.001, respectively). The average birth weight of the Syrian refugees was lower but the number of low birth weight babies was higher Turkish locals (p=0.010 and p=0.014, respectively). The preterm birth ratio and low birth weight ratio in Syrian adolescents has decreased over the years. CONCLUSION: Syrian adolescent refugees are particularly at risk of early pregnancy, high fertility rate, preterm birth, low birth weight, and anemia. Immigrant women should be provided with fertility, family planning, and training on behavior that protects reproductive health. Syrian pregnant women should be supported to receive services.

Download Full-text

Short-Form Application of the Screening Test of Spanish Grammar and the Northwestern Syntax Screening Test to Latino Children

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.0904.220 ◽

1978 ◽

Vol 9 (4) ◽

pp. 220-235

Author(s):

David L. Ratusnik ◽

Carol Melnick Ratusnik ◽

Karen Sattinger

Keyword(s):

New York ◽

Case Studies ◽

Metropolitan Area ◽

Screening Test ◽

Normative Data ◽

Short Form ◽

Latino Children ◽

Data Application ◽

York Metropolitan Area ◽

Multiple Regression Technique

Short-form versions of the Screening Test of Spanish Grammar (Toronto, 1973) and the Northwestern Syntax Screening Test (Lee, 1971) were devised for use with bilingual Latino children while preserving the original normative data. Application of a multiple regression technique to data collected on 60 lower social status Latino children (four years and six months to seven years and one month) from Spanish Harlem and Yonkers, New York, yielded a small but powerful set of predictor items from the Spanish and English tests. Clinicians may make rapid and accurate predictions of STSG or NSST total screening scores from administration of substantially shortened versions of the instruments. Case studies of Latino children from Chicago and Miami serve to cross-validate the procedure outside the New York metropolitan area.

Download Full-text

Computer-Managed Screening for Communication Disorders

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.1502.66 ◽

1984 ◽

Vol 15 (2) ◽

pp. 66-69 ◽

Cited By ~ 5

Author(s):

James L. Fitch ◽

Linda Allen Davis ◽

W. Bryce Evans ◽

Daniel E. Sellers

Keyword(s):

Satisfactory Agreement ◽

Screening Test ◽

Communication Disorders ◽

Pencil And Paper ◽

Paper Format

Fifty children were administered a screening test for communication disorders under two conditions. Under one condition graduate clinicians administered the test in the traditional pencil and paper format. Under the second condition nonprofessionals administered a computer-managed version of the same test. It was found that the computer-managed screening test yielded satisfactory agreement for the language sections. The results of the articulation section of the screening test were ambiguous.

Download Full-text