941 Post-Operative Outcomes of Patients Undergoing Surgery During the Acceleration Period of COVID-19 Infection

Abstract Introduction There are concerns around the safety of performing surgery during COVID-19 outbreaks with few sources of robust evidence. Method We analysed 5020 consecutive patients who underwent surgery during the acceleration phase of COVID-19 at our hospital from 31st January to 13th April 2020. Data were also analysed for all patients who had a COVID-19 positive test result during the same study period. Results 156 patients (3%) developed COVID-19 symptoms after surgery; 28 patients (<1%) subsequently had a positive swab result. All-cause mortality was 44 patients (0.9%); 33 deaths (75%) were due to non COVID-19 diagnoses. There were no adverse COVID-19 related outcomes in any of the 648 patients who had cancer operations. Of 28 COVID-19 positive patients, 11 died (8 orthopaedic, 2 urology, 1 vascular surgery) of which 10 had an emergency admission; all were over 70 years of age. Recent surgery was not an independent prognostic factor for survival after COVID-19 infection. 12% of positive COVID-19 swabs were from long-stay patients. Conclusions Of 5020 operative patients, 0.2% died from COVID-19 and most complications were not related to the infection. With careful consideration, surgery can be provided safely during times of COVID-19 outbreaks with particular emphasis on avoiding in-hospital transmission.

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Foundational Statistical Principles in Medical Research: Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value

Medicina ◽

10.3390/medicina57050503 ◽

2021 ◽

Vol 57 (5) ◽

pp. 503

Author(s):

Thomas F. Monaghan ◽

Syed N. Rahman ◽

Christina W. Agudelo ◽

Alan J. Wein ◽

Jason M. Lazar ◽

...

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Medical Literature ◽

Disease Prevalence ◽

Positive Test Result ◽

Predictive Values ◽

Sensitivity Specificity ◽

Test Result ◽

Test Probability

Sensitivity, which denotes the proportion of subjects correctly given a positive assignment out of all subjects who are actually positive for the outcome, indicates how well a test can classify subjects who truly have the outcome of interest. Specificity, which denotes the proportion of subjects correctly given a negative assignment out of all subjects who are actually negative for the outcome, indicates how well a test can classify subjects who truly do not have the outcome of interest. Positive predictive value reflects the proportion of subjects with a positive test result who truly have the outcome of interest. Negative predictive value reflects the proportion of subjects with a negative test result who truly do not have the outcome of interest. Sensitivity and specificity are inversely related, wherein one increases as the other decreases, but are generally considered stable for a given test, whereas positive and negative predictive values do inherently vary with pre-test probability (e.g., changes in population disease prevalence). This article will further detail the concepts of sensitivity, specificity, and predictive values using a recent real-world example from the medical literature.

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COVID-19 positive test result from a private hospital laboratory: Neglecting to report and problems with national infection control

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.93 ◽

2020 ◽

Vol 41 (7) ◽

pp. 875-876 ◽

Cited By ~ 1

Author(s):

Won Sriwijiatalai ◽

Viroj Wiwanitkit

Keyword(s):

Infection Control ◽

Private Hospital ◽

Positive Test ◽

Positive Test Result ◽

Hospital Laboratory ◽

Test Result

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Basic Predictive Risk Factors for Cytokine Storms in COVID-19 Patients

Frontiers in Immunology ◽

10.3389/fimmu.2021.745515 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sergey G. Shcherbak ◽

Anna Yu Anisenkova ◽

Sergei V. Mosenko ◽

Oleg S. Glotov ◽

Alexander N. Chernov ◽

...

Keyword(s):

Risk Factors ◽

Lymphocyte Count ◽

Absolute Lymphocyte Count ◽

Early Warning Score ◽

Positive Test ◽

City Hospital ◽

Cytokine Storm ◽

Positive Test Result ◽

Test Result ◽

D Dimer

ObjectiveA critical role in coronavirus disease 2019 (COVID-19) pathogenesis is played by immune dysregulation that leads to a generalized uncontrolled multisystem inflammatory response, caused by overproduction of proinflammatory cytokines, known as “a cytokine storm” (CS), strongly associated with a severe course of disease. The aim of this study is to identify prognostic biomarkers for CS development in COVID-19 patients and integrate them into a prognostic score for CS-associated risk applicable to routine clinical practice.Materials and MethodsThe authors performed a review of 458 medical records from COVID-19 patients (241 men and 217 women aged 60.0 ± 10.0) who received treatment in the St. Petersburg State Budgetary Institution of Healthcare City Hospital 40 (City Hospital 40, St. Petersburg), from Apr. 18, 2020 to Nov. 21, 2020. The patients were split in two groups: one group included 100 patients with moderate disease symptoms; the other group included 358 patients with progressive moderately severe, severe, and extremely severe disease. The National Early Warning Score (NEWS) score was used alongside with clinical assessment, chest computed tomographic (CT) scans, electrocardiography (ECG), and lab tests, like ferritin, C-reactive protein (CRP), interleukin (IL)-6, lactate dehydrogenase (LDH), and D-dimer.ResultsThe basic risk factors for cytokine storms in COVID-19 patients are male gender, age over 40 years, positive test result for replicative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, absolute lymphocyte count, dynamics in the NEWS score, as well as LDH, D-dimer, ferritin, and IL-6 levels. These clinical and instrumental findings can be also used as laboratory biomarkers for diagnosis and dynamic monitoring of cytokine storms. The suggested prognostic scale (including the NEWS score dynamics; serum IL-6 greater than 23 pg/ml; serum CRP 50 mg/L or greater; absolute lymphocyte count less than 0.72 × 109/L; positive test result for replicative coronavirus (SARS-CoV-2) RNA; age 40 years and over) is a useful tool to identify patients at a high risk for cytokine storm, requiring an early onset of anti-inflammatory therapy.

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Risk of hospital admission with covid-19 among teachers compared with healthcare workers and other adults of working age in Scotland, March 2020 to July 2021: population based case-control study

BMJ ◽

10.1136/bmj.n2060 ◽

2021 ◽

pp. n2060

Author(s):

Lynda Fenton ◽

Ciara Gribben ◽

David Caldwell ◽

Sam Colville ◽

Jen Bishop ◽

...

Keyword(s):

General Population ◽

Hospital Admission ◽

Healthcare Workers ◽

Population Based ◽

Positive Test ◽

Positive Test Result ◽

Working Age ◽

Household Members ◽

Test Result ◽

Control Study

Abstract Objective To determine the risk of hospital admission with covid-19 and severe covid-19 among teachers and their household members, overall and compared with healthcare workers and adults of working age in the general population. Design Population based nested case-control study. Setting Scotland, March 2020 to July 2021, during defined periods of school closures and full openings in response to covid-19. Participants All cases of covid-19 in adults aged 21 to 65 (n=132 420) and a random sample of controls matched on age, sex, and general practice (n=1 306 566). Adults were identified as actively teaching in a Scottish school by the General Teaching Council for Scotland, and their household members were identified through the unique property reference number. The comparator groups were adults identified as healthcare workers in Scotland, their household members, and the remaining general population of working age. Main outcome measures The primary outcome was hospital admission with covid-19, defined as having a positive test result for SARS-CoV-2 during hospital admission, being admitted to hospital within 28 days of a positive test result, or receiving a diagnosis of covid-19 on discharge from hospital. Severe covid-19 was defined as being admitted to intensive care or dying within 28 days of a positive test result or assigned covid-19 as a cause of death. Results Most teachers were young (mean age 42), were women (80%), and had no comorbidities (84%). The risk (cumulative incidence) of hospital admission with covid-19 was <1% for all adults of working age in the general population. Over the study period, in conditional logistic regression models adjusted for age, sex, general practice, race/ethnicity, deprivation, number of comorbidities, and number of adults in the household, teachers showed a lower risk of hospital admission with covid-19 (rate ratio 0.77, 95% confidence interval 0.64 to 0.92) and of severe covid-19 (0.56, 0.33 to 0.97) than the general population. In the first period when schools in Scotland reopened, in autumn 2020, the rate ratio for hospital admission in teachers was 1.20 (0.89 to 1.61) and for severe covid-19 was 0.45 (0.13 to 1.55). The corresponding findings for household members of teachers were 0.91 (0.67 to 1.23) and 0.73 (0.37 to 1.44), and for patient facing healthcare workers were 2.08 (1.73 to 2.50) and 2.26 (1.43 to 3.59). Similar risks were seen for teachers in the second period, when schools reopened in summer 2021. These values were higher than those seen in spring/summer 2020, when schools were mostly closed. Conclusion Compared with adults of working age who are otherwise similar, teachers and their household members were not found to be at increased risk of hospital admission with covid-19 and were found to be at lower risk of severe covid-19. These findings should reassure those who are engaged in face-to-face teaching.

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Explaining a Positive Test Result to a Patient

Teaching Statistics ◽

10.1111/j.1467-9639.2009.00377.x ◽

2010 ◽

Vol 32 (3) ◽

pp. 76-77

Author(s):

Xian-Jin Xie

Keyword(s):

Positive Test ◽

Positive Test Result ◽

Test Result

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The Association between Diagnosis of Plantar Fasciitis and Windlass Test Results

Foot & Ankle International ◽

10.1177/107110070302400309 ◽

2003 ◽

Vol 24 (3) ◽

pp. 251-255 ◽

Cited By ~ 28

Author(s):

Denise De Garceau ◽

Danielle Dean ◽

Susan Mais Requejo ◽

David B. Thordarson

Keyword(s):

Plantar Fasciitis ◽

The Other ◽

High Rate ◽

Control Group ◽

Test Results ◽

Foot Pain ◽

Positive Test Result ◽

Pain Group ◽

Test Result ◽

Low Rate

Twenty-two patients with plantar fasciitis, 23 patients with other types of foot pain, and 30 patients in a control group were evaluated with the Windlass test performed in a weightbearing and non-weightbearing position. In the non-weightbearing test, the first MP joint was maximally dorsiflexed with the ankle stabilized. The weightbearing test was performed with the toes hanging off the edge of a stool and dorsiflexion of the first MP was performed. Seven of the 22 patients in the plantar fasciitis group had a positive weightbearing Windlass test (31.8%), while only three had a positive test result in a non-weightbearing position (13.6%). None of the patients in the other foot pain group or control group had pain in the weightbearing and non-weightbearing positions. Despite its high rate of specificity, the low rate of sensitivity of the Windlass test may limit its usefulness in the clinical evaluation in patients with plantar fasciitis.

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‘Immunity Passports’ for SARS-CoV-2: an online experimental study of the impact of antibody test terminology on perceived risk and behaviour

BMJ Open ◽

10.1136/bmjopen-2020-040448 ◽

2020 ◽

Vol 10 (8) ◽

pp. e040448

Author(s):

Jo Waller ◽

G James Rubin ◽

Henry W W Potts ◽

Abigail L Mottershaw ◽

Theresa M Marteau

Keyword(s):

Perceived Risk ◽

Antibody Test ◽

Open Science ◽

Hand Washing ◽

Physical Contact ◽

Positive Test ◽

Positive Test Result ◽

Risk Of Infection ◽

The Impact ◽

Test Result

ObjectiveTo assess the impact of describing an antibody-positive test result using the terms Immunity and Passport or Certificate, alone or in combination, on perceived risk of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and protective behaviours.Design2×3 experimental design.SettingOnline.Participants1204 adults from a UK research panel.InterventionParticipants were randomised to receive one of six descriptions of an antibody test and results showing SARS-CoV-2 antibodies, differing in the terms describing the type of test (Immunity vs Antibody) and the test result (Passport vs Certificate vs Test).Main outcome measuresPrimary outcome: proportion of participants perceiving no risk of infection with SARS-CoV-2 given an antibody-positive test result. Other outcomes include: intended changes to frequency of hand washing and physical distancing.ResultsWhen using the term Immunity (vs Antibody), 19.1% of participants (95% CI 16.1% to 22.5%) (vs 9.8% (95% CI 7.5% to 12.4%)) perceived no risk of catching coronavirus given an antibody-positive test result (adjusted OR (AOR): 2.91 (95% CI 1.52 to 5.55)). Using the terms Passport or Certificate—as opposed to Test—had no significant effect (AOR: 1.24 (95% CI 0.62 to 2.48) and AOR: 0.96 (95% CI 0.47 to 1.99) respectively). There was no significant interaction between the effects of the test and result terminology. Across groups, perceiving no risk of infection was associated with an intention to wash hands less frequently (AOR: 2.32 (95% CI 1.25 to 4.28)); there was no significant association with intended avoidance of physical contact (AOR: 1.37 (95% CI 0.93 to 2.03)).ConclusionsUsing the term Immunity (vs Antibody) to describe antibody tests for SARS-CoV-2 increases the proportion of people believing that an antibody-positive result means they have no risk of catching coronavirus in the future, a perception that may be associated with less frequent hand washing.Trial registration numberOpen Science Framework: https://osf.io/tjwz8/files/

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The direct and indirect impact of the COVID-19 pandemic on the care of patients with pituitary disease: a cross sectional study

Pituitary ◽

10.1007/s11102-020-01106-3 ◽

2020 ◽

Author(s):

Anneke Graf ◽

Hani J. Marcus ◽

Stephanie E. Baldeweg

Keyword(s):

Adrenal Insufficiency ◽

Study Design ◽

Telephone Survey ◽

Cross Sectional Study ◽

Positive Test Result ◽

Sectional Study ◽

Cross Sectional ◽

Pituitary Disease ◽

Indirect Impact ◽

Test Result

Abstract Purpose The coronavirus disease 2019 (COVID-19) pandemic is widely believed to have had a major impact on the care of patients with pituitary disease. The virus itself may directly result in death, and patients with adrenal insufficiency, often a part of hypopituitarism, are thought to represent a particularly susceptible subgroup. Moreover, even in patients that do not contract the virus, the diversion of resources by healthcare institutions to manage the virus may indirectly result in delays in their management. To this end, the aim of this study was to determine the direct and indirect impact of the COVID-19 pandemic on patients with pituitary disease. Methods A cross-sectional study design was adopted, with all adult patients seen by our pituitary service in the year prior to the nationwide lockdown on March 23rd 2020 invited to participate in a telephone survey. Results In all, 412 patients (412/586; 70.3%) participated in the survey. 66 patients (66/412; 16.0%) reported having suspected COVID-19 infection. Of the 10 patients in this group tested for COVID-19 infection, three received a positive test result. No deaths due to COVID-19 were identified. 267 patients (267/412; 64.8%) experienced a delay or change in the planned care for their pituitary disease, with 100 patients (100/412; 24.3%) perceiving an impact to their care. Conclusions Whilst only a small percentage of patients had confirmed or suspected COVID-19 infection, over half were still indirectly impacted by the pandemic through a delay or change to their planned care.

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Clinical predictors of a positive test result in patients undergoing genetic evaluation for a hereditary kidney cancer syndrome

Canadian Urological Association Journal ◽

10.5489/cuaj.6264 ◽

2019 ◽

Vol 14 (8) ◽

Author(s):

Andrea Kokorovic ◽

Aidan Thomas ◽

Jesus Serrano-Lomelin ◽

Meghan Ferguson ◽

Ricardo A. Rendon

Keyword(s):

High Risk ◽

Kidney Cancer ◽

Genetic Counselling ◽

Real Life ◽

Medical Genetics ◽

Positive Test ◽

Positive Test Result ◽

Clinical Implementation ◽

Cancer Syndrome ◽

Test Result

Introduction: Guidelines are available to assist providers in identifying patients with renal cell carcinoma (RCC) that may benefit from genetic counselling, however, the evidence for these recommendations lacks support from the literature and controversy remains as to who should be referred. We aimed to delineate risk factors associated with a positive genetic test in a real-life cohort of patients with RCC referred to a regional medical genetics unit for evaluation of a hereditary kidney cancer syndrome. Methods: Patients with a diagnosis of RCC referred to Maritime Medical Genetics Service (Nova Scotia, Canada) from 2006–2017 were reviewed using retrospective data. The primary outcome was identification of clinical features that were associated with a positive test result. Logistic regression models were used for analysis. Results: A total of 135 patients were referred to medical genetics for evaluation; 102 patients were evaluated, 75 underwent testing, and 74 were included in the final analysis. Five patients tested positive: three Birt Hogg Dube, one Cowden syndrome, and one Von Hippel Lindau. Presence of dermatological lesions (specifically fibrofolliculomas) and more than two high-risk features were the only predictors of a positive test result. Conclusions: The presence of dermatological lesions and more than two high-risk features are the only predictors of a positive test result in patients with a suspected hereditary kidney cancer syndrome. These findings are not reflected in current guidelines, and the clinical implementation of our results may improve the identification of high-risk patients for genetic counselling.

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