Screening the apparently healthy athlete for risk: a paradigm in transition

2017 ◽  
Vol 27 (S1) ◽  
pp. S89-S93 ◽  
Author(s):  
Joshua D. Kurtz ◽  
Ronald J. Kanter ◽  
Melissa Olen ◽  
Anthony F. Rossi
Keyword(s):  
Primary Prevention ◽  
False Positive ◽  
False Positive Rate ◽  
Case Series ◽  
Cost Effective ◽  
Risk Groups ◽  
Screening Tools ◽  
Retrospective Case ◽  
European Society Of Cardiology ◽  
Healthy Athlete

AbstractIt has largely been accepted that pre-participation screening for student athletes is necessary, but there is still no consensus on the most effective and efficient ways to accomplish this. Most clinical strategies are based on retrospective case series. By applying the European Society of Cardiology and Seattle criteria, electrocardiography appears to afford the lowest false-positive rate for identifying potentially dangerous cardiac abnormalities in athletes. Prospective, randomised trials may help determine the most effective primary prevention. Normative data for age, gender, and ethnicity for screening tools need to be formulated to further reduce false-positive results. Targeted advanced screening aimed at the highest risk groups may be the most beneficial and cost-effective application of primary prevention.

Venous Flow Coupler in Head and Neck Free Flap Reconstruction

2020 ◽  
pp. 019459982095309
Author(s):  
Scott H. Troob ◽  
Quinn Self ◽  
Deniz Gerecci ◽  
Macgregor Hodgson ◽  
Javier González-Castro ◽  
...  
Keyword(s):  
Free Flap ◽  
Predictive Value ◽  
False Positive ◽  
False Positive Rate ◽  
Case Series ◽  
Arterial Flow ◽  
Retrospective Case ◽  
Venous Flow ◽  
Retrospective Case Series ◽  
Positive Rate

Objective To describe the utility of venous flow couplers in monitoring free tissue flaps in the immediate postoperative setting. Study Design Retrospective case series. Setting Otolaryngology department at a single tertiary care institution. Methods A retrospective case series of free flap reconstructions in which venous flow couplers were employed to supplement flap monitoring. All free flap cases performed over the past 4 years were reviewed. Inclusion criteria were venous flow coupler and arterial flow Doppler monitored for 5 days postoperatively. Results From July 2014 through May 2018, the venous flow coupler was used with the arterial flow Doppler and clinical monitoring in 228 cases. Eleven cases did not meet criteria for inclusion; thus, 217 cases were analyzed. Twenty cases (9.2%) returned to the operating room with concern for flap compromise, and 16 were salvaged. The combination of venous flow coupler and arterial flow Doppler identified 19 of these flaps. Venous flow couplers identified 5 compromised flaps before there was an arterial signal change, and all were salvaged. Additionally, there was a 24.1% false-positive rate when 2 venous flow couplers were used in parallel. For the venous flow coupler, the positive predictive value was 64.3% and the negative predictive value, 98.9%. The false-positive rate in the series was 5.1%. The sensitivity was 90% and the specificity, 94.9%. Conclusion The venous flow coupler is able to detect venous thrombosis in the absence of arterial thrombosis and may contribute to improved flap salvage rates.

Concurrent surgeries in ENT: a cost-effective and safe approach in patients requiring multiple definitive procedures

2004 ◽  
Vol 118 (1) ◽  
pp. 31-33 ◽  
Author(s):  
Achamma Balraj ◽  
Mary Kurien ◽  
Anand Job
Keyword(s):  
Surgical Procedures ◽  
Tertiary Care ◽  
Case Series ◽  
Cost Effective ◽  
Definitive Treatment ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
Average Hospital ◽  
Duration Of Surgery

Treatment of the predisposing factors that are identified in the nose and throat in several ENT diseases is mandatory prior to the definitive management of the latter. When surgical management is indicated it has been traditional to use staged procedures. This study was undertaken to assess the role of concurrent surgical procedures in ENT and evaluate their cost-effectiveness compared to similar staged procedures. This was a retrospective case series of 100 consecutive patients undergoing concurrent and similar staged ENT surgical procedures. On analysis, it was noted that the average duration of surgery, anaesthesia and hospital stay was significantly less in the concurrent procedures group than in the staged procedures (2.35/3.1.hours; 3.05/3.30.hours and 2.5/6.5 days, respectively). The average hospital bill for the concurrent procedures was also lower than for the staged procedures. Hence, in patients requiring multiple ENT surgical procedures for definitive treatment, concurrent procedures are more cost-effective than staged procedures and should be considered the treatment of choice in a tertiary care centre.

scholarly journals Tuberculosis screening costs and cost-effectiveness in high-risk groups: a systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
H. Alsdurf ◽  
B. Empringham ◽  
C. Miller ◽  
A. Zwerling
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cost Effectiveness ◽  
High Risk ◽  
Cost Effective ◽  
Risk Groups ◽  
Screening Tools ◽  
Molecular Diagnostic ◽  
Systematic Screening ◽  
Structural Risk

Abstract Background Systematic screening for active tuberculosis (TB) is a strategy which requires the health system to seek out individuals, rather than waiting for individuals to self-present with symptoms (i.e., passive case finding). Our review aimed to summarize the current economic evidence and understand the costs and cost-effectiveness of systematic screening approaches among high-risk groups and settings. Methods We conducted a systematic review on economic evaluations of screening for TB disease targeting persons with clinical and/or structural risk factors, such as persons living with HIV (PLHIV) or persons experiencing homelessness. We searched three databases for studies published between January 1, 2010 and February 1, 2020. Studies were included if they reported cost and a key outcome measure. Owing to considerable heterogeneity in settings and type of screening strategy, we synthesized data descriptively. Results A total of 27 articles were included in our review; 19/27 (70%) took place in high TB burden countries. Seventeen studies took place among persons with clinical risk factors, including 14 among PLHIV, while 13 studies were among persons with structural risk factors. Nine studies reported incremental cost-effectiveness ratios (ICERs) ranging from US$51 to $1980 per disability-adjusted life year (DALY) averted. Screening was most cost-effective among PLHIV. Among persons with clinical and structural risk factors there was limited evidence, but screening was generally not shown to be cost-effective. Conclusions Studies showed that screening is most likely to be cost-effective in a high TB prevalence population. Our review highlights that to reach the “missing millions” TB programmes should focus on simple, cheaper initial screening tools (i.e., symptom screen and CXR) followed by molecular diagnostic tools (i.e., Xpert®) among the highest risk groups in the local setting (i.e., PLHIV, urban slums). Programmatic costs greatly impact cost-effectiveness thus future research should provide both fixed and variable costs of screening interventions to improve comparability.

Routine Histopathologic Evaluation in Hallux Valgus Surgery

2009 ◽  
Vol 30 (8) ◽  
pp. 763-766 ◽  
Author(s):  
Irvin C. Oh ◽  
Scott J. Ellis ◽  
Martin J. O'Malley
Keyword(s):  
Cost Effectiveness ◽  
Hallux Valgus ◽  
Gouty Arthritis ◽  
Case Series ◽  
Cost Effective ◽  
Postoperative Management ◽  
Degenerative Changes ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
New Diagnosis

Background: Anecdotal evidence suggests that specimens submitted for histopathologic assessment during hallux valgus surgery most commonly reveal degenerative changes. The purpose of this study was to evaluate the cost effectiveness of routine examination of tissue from hallux valgus procedures. We hypothesized that such examination rarely diagnoses a new condition and does not alter postoperative management. Materials and Methods: Specimens from 315 consecutive primary hallux valgus reconstructions performed between November 1995 and August 2002 were retrospectively analyzed. Patient charts were reviewed to determine the number of cases in which new diagnoses were made or treatment altered based upon histopathologic examination. Cost effectiveness was assessed by identifying the reimbursement for professional fees charged for these analyses. The total reimbursement per new diagnosis made and per alteration of treatment were calculated. Results: Degenerative changes were diagnosed in the majority of speciments (97.5%, 307 of 315). Other diagnoses included rheumatoid arthritis (1.3%, four of 315), gouty arthritis (1.0%, three of 315), and pseudogout (0.3%, one of 315). A new diagnosis was made only in the one patient (0.3%, one of 315) with pseudogout. Postoperative management was unchanged in every case. Conclusion: Routine submission of specimens obtained during hallux valgus surgery is not cost effective. New diagnoses are very rare and postoperative management did not change. Level of Evidence: IV, Retrospective Case Series

Recent advances in superior semicircular canal dehiscence syndrome

2015 ◽  
Vol 129 (3) ◽  
pp. 217-225 ◽  
Author(s):  
G Chilvers ◽  
I McKay-Davies
Keyword(s):  
Semicircular Canal ◽  
Health Management ◽  
Case Reports ◽  
False Positive Rate ◽  
Case Series ◽  
Vestibular Evoked Myogenic Potential ◽  
Retrospective Case ◽  
Superior Semicircular Canal Dehiscence ◽  
Superior Semicircular Canal ◽  
Canal Dehiscence

AbstractObjective:This study aimed to review the current advances in superior semicircular canal dehiscence syndrome and to ascertain its aetiology, whether dehiscence size correlates with symptoms, signs and investigation results, the best investigations, and its surgical management.Methods:A literature search using the key words ‘superior semicircular canal dehiscence’ was performed using the Allied and Complementary Medicine Database and the Embase, Health Management Information Consortium, Medline, PsycINFO, British Nursing Index, Cinahl and Health Business Elite databases for the period January 2009 to May 2014. Systematic reviews, meta-analyses, randomised controlled trials, prospective and retrospective case series, case reports, and observational studies were included.Results:Of the 205 papers identified, 35 were considered relevant.Conclusion:The aetiology of superior semicircular canal dehiscence syndrome is unclear. Dehiscence size significantly affects the air–bone gap and ocular vestibular evoked myogenic potential thresholds. Computed tomography evaluation has a high false positive rate. The middle cranial fossa approach is the surgical standard for treating this syndrome; however, the transmastoid approach is gaining popularity.

scholarly journals Clinical Utility of a Plasma-Based miRNA Signature Classifier Within Computed Tomography Lung Cancer Screening: A Correlative MILD Trial Study

2014 ◽  
Vol 32 (8) ◽  
pp. 768-773 ◽  
Author(s):  
Gabriella Sozzi ◽  
Mattia Boeri ◽  
Marta Rossi ◽  
Carla Verri ◽  
Paola Suatoni ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Validation Study ◽  
False Positive ◽  
Diagnostic Performance ◽  
False Positive Rate ◽  
Lung Cancer Screening ◽  
Risk Groups ◽  
Positive Rate

Purpose Recent screening trial results indicate that low-dose computed tomography (LDCT) reduces lung cancer mortality in high-risk patients. However, high false-positive rates, costs, and potential harms highlight the need for complementary biomarkers. The diagnostic performance of a noninvasive plasma microRNA signature classifier (MSC) was retrospectively evaluated in samples prospectively collected from smokers within the randomized Multicenter Italian Lung Detection (MILD) trial. Patients and Methods Plasma samples from 939 participants, including 69 patients with lung cancer and 870 disease-free individuals (n = 652, LDCT arm; n = 287, observation arm) were analyzed by using a quantitative reverse transcriptase polymerase chain reaction–based assay for MSC. Diagnostic performance of MSC was evaluated in a blinded validation study that used prespecified risk groups. Results The diagnostic performance of MSC for lung cancer detection was 87% for sensitivity and 81% for specificity across both arms, and 88% and 80%, respectively, in the LDCT arm. For all patients, MSC had a negative predictive value of 99% and 99.86% for detection and death as a result of disease, respectively. LDCT had sensitivity of 79% and specificity of 81% with a false-positive rate of 19.4%. Diagnostic performance of MSC was confirmed by time dependency analysis. Combination of both MSC and LDCT resulted in a five-fold reduction of LDCT false-positive rate to 3.7%. MSC risk groups were significantly associated with survival (χ12 = 49.53; P < .001). Conclusion This large validation study indicates that MSC has predictive, diagnostic, and prognostic value and could reduce the false-positive rate of LDCT, thus improving the efficacy of lung cancer screening.

scholarly journals Limitations of multidetector computed tomography angiography for the diagnosis of blunt cerebrovascular injury

2018 ◽  
Vol 128 (6) ◽  
pp. 1642-1647 ◽  
Author(s):  
Ramesh Grandhi ◽  
Gregory M. Weiner ◽  
Nitin Agarwal ◽  
David M. Panczykowski ◽  
William J. Ares ◽  
...  
Keyword(s):  
False Positive ◽  
Antithrombotic Therapy ◽  
Multidetector Ct ◽  
False Positive Rate ◽  
Cost Effective ◽  
Blunt Cerebrovascular Injury ◽  
Cerebrovascular Injury ◽  
Current Series ◽  
Positive Rate ◽  
Level I

OBJECTIVEBlunt cerebrovascular injuries (BCVIs) following trauma carry risk for morbidity and mortality. Since patients with BCVI are often asymptomatic at presentation and neurological sequelae often occur within 72 hours, timely diagnosis is essential. Multidetector CT angiography (CTA) has been shown to be a noninvasive, cost-effective, reliable means of screening; however, the false-positive rate of CTA in diagnosing patients with BCVI represents a key drawback. Therefore, the authors assessed the role of DSA in the screening of BCVI when utilizing CTA as the initial screening modality.METHODSThe authors performed a retrospective analysis of patients who experienced BCVI between 2013 and 2015 at 2 Level I trauma centers. All patients underwent CTA screening for BCVI according to the updated Denver Screening Criteria. Patients who were diagnosed with BCVI on CTA underwent confirmatory digital subtraction angiography (DSA). Patient demographics, screening indication, BCVI grade on CTA and DSA, and laboratory values were collected. Comparison of false-positive rates stratified by BCVI grade on CTA was performed using the chi-square test.RESULTSA total of 140 patients (64% males, mean age 50 years) with 156 cerebrovascular blunt injuries to the carotid and/or vertebral arteries were identified. After comparison with DSA findings, CTA findings were incorrect in 61.5% of vessels studied, and the overall CTA false-positive rates were 47.4% of vessels studied and 47.9% of patients screened. The positive predictive value (PPV) for CTA was higher among worse BCVI subtypes on initial imaging (PPV 76% and 97%, for BCVI Grades II and IV, respectively) compared with Grade I injuries (PPV 30%, p < 0.001).CONCLUSIONSIn the current series, multidetector CTA as a screening test for blunt cerebrovascular injury had a high-false positive rate, especially in patients with Grade I BCVI. Given a false-positive rate of 47.9% with an estimated average of 132 patients per year screening positive for BCVI with CTA, approximately 63 patients per year would potentially be treated unnecessarily with antithrombotic therapy at a busy United States Level I trauma center. The authors’ data support the use of DSA after positive findings on CTA in patients with suspected BCVI. DSA as an adjunctive test in patients with positive CTA findings allows for increased diagnostic accuracy in correctly diagnosing BCVI while minimizing risk from unnecessary antithrombotic therapy in polytrauma patients.

scholarly journals OUTCOME OF SINGLE STAGE SPHINCTER SPARING SCARLESS ( 5S) PROCEDURE FOR RECTOVESTIBULAR FISTULA: A RETROSPECTIVE ANALYSIS

2020 ◽  
Vol 8 (11) ◽  
pp. 34-41
Author(s):  
Muhammad Riaz-Ul-Haq ◽  
◽  
Muhammad Kashif Chishti ◽  
Arsalan Raza Wasti ◽  
Mazhar Jam ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Case Series ◽  
Cost Effective ◽  
Anorectal Malformations ◽  
Single Stage ◽  
Anal Stenosis ◽  
Paediatric Surgery ◽  
Retrospective Case ◽  
Renal Anomalies ◽  
Vestibular Fistula

Background: Anorectal malformations (ARM) in girls comprise of a wide spectrum of disease ranging from imperforate anus to common cloaca, a complex malformation. Recto-vestibular fistula (RVF) is the commonest ARM in female patients. Many surgical procedures have been mentioned in the literature but trend is changing from staged to single stage procedure. Objectives: To evaluate post operative results of Single Stage Sphincter Sparing Scarless (5S) procedure for RVF. Methods: It is a retrospective case series of 24 patients with RVF who were admitted in the Department of Paediatric Surgery Jinnah Hospital Lahore and the Children Hospital and the Institute of Child Health Multan from October 2018 to September 2019, between 14 days and 4 years of age , underwent single stage sphincter sparing scarless procedure without any colostomy, anterior or posterior midline incision or division of sphincteric complex. Site of neo-anus was marked with the help of muscle stimulator and all surgeries were done under general anesthesia after meticulous gut preparation. Post operatively patients were kept nil per oral for 5 days to avoid wound contamination due to stool. Follow up was done for six months to evaluate outcome. Authors used a new name for single stage procedure. Results: Mean age was 160 days, operative time 78 minutes and hospital stay 6.8 days. 9 (37.5%) patients were diagnosed with some other associated congenital anomalies like congenital heart disease (CHD), renal anomalies, hemisacrum, syndactyly, talipes equino varus(TEV) and Downs syndrome. As a whole 13(24) presented with complication. 4(16.64%) patients presented with constipation, 3(12.5%) excoriation, 2(8.32%) anal stenosis, 2(8.32%) soiling, 1(4.16%) retraction of rectum and 1(4.16%) superficial wound infection. Patient with retraction was planned for re-do surgery, all others were managed conservatively. Conclusion: Single stage sphincter sparing scarless ( 5S) procedure for recto-vestibular fistula is safe, simple and cost effective technique. Patient suffering is minimum, as there is no colostomy, so no multiple surgeries. Complications are minimum and comparable to staged procedure.

scholarly journals 083 Novel wireless S – patch device may efficiently detect atrial fibrillation in patients with ischaemic stroke

2019 ◽  
Vol 90 (e7) ◽  
pp. A26.3-A27 ◽  
Author(s):  
Suzana Lazarovska ◽  
Hui Tie ◽  
Andrew Hopkins ◽  
Hany Dimitri ◽  
Upul Premawardhana ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
False Positive ◽  
Detection Rate ◽  
False Positive Rate ◽  
Case Series ◽  
Time Saving ◽  
Novel Device ◽  
Increased Risk ◽  
Positive Rate ◽  
Prospective Case Series

IntroductionAtrial fibrillation (AF) is the most common atrial arrhythmia leading to increased risk of thromboembolic events. Ward telemetry (WT) has a low detection rate for AF in stroke patients and often patients are not appropriately treated with anticoagulation. This study compares conventional 2-day WT versus 4-day wireless S-patch monitoring to detect AF.MethodsProspective case series.Results51 patients admitted for stroke workup were recruited across 2 major tertiary centre’s in Sydney to compare WT monitoring for 2 days versus S-patch monitoring for 4 days in the detection of AF. The efficacy to detect AF using both technologies across 76 hours of telemetry was assessed via data extractions and Cardiologist review. A matrix was used to measure nursing/patient satisfaction and setup/resource times were assessed.84–94% of patients and 75–95% of nursing preferred the S-Patch. Non-parametric tests indicate significant time saving for removal of S-Patch versus WT [2.2 mins vs 5.1 mins (p=0.00)]. Efficacy of S-Patch to detect AF following Cardiologist review was greater than WT, with 7 patients identified with AF by S-Patch versus 1 using WT. The S-patch had a false positive rate of 78%.ConclusionThe S-patch had a higher detection rate of AF compared to WT. This allows patients to be anticoagulated appropriately for the prevention of further stroke. Analysis shows patients and staff overwhelmingly prefer the S-Patch. The S-Patch is sensitive in the detection of AF however it showed a high false positive rate. We are confident that further refinement and advances will provide a novel device in the detection of AF.

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